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Douglas AD, Puzio TJ, Murphy PB, Kinnaman GB, Meagher AD. Pack the chest: Damage control strategy for management in thoracic trauma. Injury 2024; 55:111490. [PMID: 38523031 DOI: 10.1016/j.injury.2024.111490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 01/30/2024] [Accepted: 03/02/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Damage control surgery aims to control hemorrhage and contamination in the operating room (OR) with definitive management of injuries delayed until normal physiology is restored in the intensive care unit (ICU). There are limited studies evaluating the use of damage control thoracotomy (DCT) in trauma, and the best method of temporary closure is unclear. METHODS A retrospective review of trauma patients at two level I trauma centers who underwent a thoracotomy operation was performed. Subjects who underwent a thoracotomy after 24 h, age less than 16, expired in the trauma bay, or in the OR prior to ICU admission were excluded. One-way ANOVA and Kruskal-Wallis test were used to compare continuous and categorical variables between DCT and definitive thoracotomy (DT) patients. RESULTS 207 trauma patients underwent thoracotomy, 76 met our inclusion criteria. DCT was performed in 30 patients (39%), 46 (61 %) underwent DT operation. Techniques for temporizing the chest varied from skin closure with suture (8), adhesive dressing (5), towel clamps (2), or negative pressure devices (12). Compared to definitive closure, DCT had more derangements in HR, pH, (110 vs. 95, p = 0.04; 7.05 vs 7.24, p < 0.001), and injury severity score (41 vs 25, p < 0.001), and required more blood transfusions (40 vs 6, p < 0.001). Eleven (36.7 %) DCT patients survived to discharge compared to 38 patients (95.0 %) in the DT group. DCT showed significantly higher differences in cardiac arrest and unplanned returns to the OR rates. No differences were observed in ventilator days, or ICU length of stay. CONCLUSIONS DCT is a viable option for management of patients in extremis following thoracic trauma. DCT was associated with higher mortality rates, likely due to differences in injury and physiologic derangement. Despite this, DCT was associated with similar rates of complications, ICU stay, and ventilator days.
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Affiliation(s)
| | - Thaddeus J Puzio
- Department of Surgery, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Patrick B Murphy
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Ashley D Meagher
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
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2
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Haislup BD, Gupta S, Fleisher I, Murthi AM, Wright MA. Funding Bias in Shoulder Arthroplasty Research. J Shoulder Elbow Surg 2024:S1058-2746(24)00264-7. [PMID: 38642875 DOI: 10.1016/j.jse.2024.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 02/10/2024] [Accepted: 03/03/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND Prior research has shown that industry funding can impact the outcomes reported in medical literature. Limited data exists on the degree of bias that industry funding may have on shoulder arthroplasty literature outside of the Journal of Shoulder and Elbow Surgery. The purpose of this study is to characterize the type and frequency of funding for recently published shoulder arthroplasty studies and the impact of industry funding on reported outcomes. We hypothesized that studies with industry funding are more likely to report positive outcomes than those without. MATERIALS/METHOD We performed a retrospective study searching all articles with the term "shoulder arthroplasty," "reverse shoulder arthroplasty," "anatomic total shoulder arthroplasty," or "total shoulder arthroplasty" on PubMed from the years January 2020 to December 2022. The primary outcome of studies was coded as either positive, negative, or neutral. A positive result was defined as one in which the null hypothesis was rejected. A negative result was defined as one in which the result did not favor the group in which the industry-funded implant was used. A neutral result was defined as one in which the null hypothesis was confirmed. Article funding type, subcategorized as National Institute of Health (NIH) funding or industry funding was recorded. Author disclosures were recorded to determine conflicts of interest. Statistical analysis was conducted using the Chi-squared test and Fisher exact test. RESULTS 750 articles reported on either conflict of interest or funding source and were included in the study. Of the total number of industry funded studies the majority were found to have a positive primary endpoint (58.1%, 104/179), as compared to a negative (7.8%, 14/179), or neutral endpoint (33.5%, 60/179) (p=0.004). 363 articles reported an author conflicts of interest and the majority of these studies had positive primary endpoint (55.6%, 202/363) as compared to negative (9.1%, 33/363) or neutral endpoints (34.4%, 125/363)(p=.002). CONCLUSION The results of this study suggest that there is a significant relationship between conflicts of interest and the primary outcome of shoulder arthroplasty studies, beyond the overall positive publication bias. Studies with industry funding and author conflicts of interest both report positive outcomes more frequently than negative outcomes. Shoulder surgeons should be aware of this potential bias when choosing to base clinical practice on published data.
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Affiliation(s)
- Brett D Haislup
- Medstar Union Memorial Hospital, Shoulder and Elbow Service, Department of Orthopaedic Surgery, Baltimore, MD, USA.
| | - Suhasini Gupta
- University of Massachusetts, T.H. Chan School of Medicine, Worcester, MA, USA
| | | | - Anand M Murthi
- Medstar Union Memorial Hospital, Shoulder and Elbow Service, Department of Orthopaedic Surgery, Baltimore, MD, USA
| | - Melissa A Wright
- Washington University, Shoulder and Elbow Service, Department of Orthopaedic Surgery, St. Louis, MO, USA
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Rafaqat W, Abiad M, Lagazzi E, Argandykov D, Proaño-Zamudio JA, Velmahos GC, Hwabejire JO, Parks JJ, Luckhurst CM, DeWane MP. Analyzing the Impact of Concomitant COVID-19 Infection on Outcomes in Trauma Patients. Am Surg 2024:31348241246176. [PMID: 38613452 DOI: 10.1177/00031348241246176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2024]
Abstract
BACKGROUND The impact of COVID-19 infection at the time of traumatic injury remains understudied. Previous studies demonstrate that the rate of COVID-19 vaccination among trauma patients remains lower than in the general population. This study aims to understand the impact of concomitant COVID-19 infection on outcomes in trauma patients. METHODS We conducted a retrospective cohort study of patients ≥18 years old admitted to a level I trauma center from March 2020 to December 2022. Patients tested for COVID-19 infection using a rapid antigen/PCR test were included. We matched patients using 2:1 propensity accounting for age, gender, race, comorbidities, vaccination status, injury severity score (ISS), type and mechanism of injury, and GCS at arrival. The primary outcome was inpatient mortality. Secondary outcomes included hospital length of stay (LOS), Intensive Care Unit (ICU) LOS, 30-day readmission, and major complications. RESULTS Of the 4448 patients included, 168 (3.8%) were positive (COV+). Compared with COVID-19-negative (COV-) patients, COV+ patients were similar in age, sex, BMI, ISS, type of injury, and regional AIS. The proportion of White and non-Hispanic patients was higher in COV- patients. Following matching, 154 COV+ and 308 COV- patients were identified. COVID-19-positive patients had a higher rate of mortality (7.8% vs 2.6%; P = .010), major complications (15.6% vs 8.4%; P = .020), and thrombotic complications (3.9% vs .6%; P = .012). Patients also had a longer hospital LOS (median, 9 vs 5 days; P < .001) and ICU LOS (median, 5 vs 3 days; P = .025). CONCLUSIONS Trauma patients with concomitant COVID-19 infection have higher mortality and morbidity in the matched population. Focused interventions aimed at recognizing this high-risk group and preventing COVID-19 infection within it should be undertaken.
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Affiliation(s)
- Wardah Rafaqat
- Division of Trauma, Emergency General Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, USA
| | - May Abiad
- Division of Trauma, Emergency General Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, USA
| | - Emanuele Lagazzi
- Division of Trauma, Emergency General Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, USA
| | - Dias Argandykov
- Division of Trauma, Emergency General Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, USA
| | - Jefferson A Proaño-Zamudio
- Division of Trauma, Emergency General Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, USA
| | - George C Velmahos
- Division of Trauma, Emergency General Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, USA
| | - John O Hwabejire
- Division of Trauma, Emergency General Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, USA
| | - Jonathan J Parks
- Division of Trauma, Emergency General Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, USA
| | - Casey M Luckhurst
- Division of Trauma, Emergency General Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, USA
| | - Michael P DeWane
- Division of Trauma, Emergency General Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, USA
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Li J, Tseng C, Yuan Y, Jiang D, Qian Z, Hu Z, Zhu Z, Qiu Y, Liu Z. Determining the association between the radiographic parameters and the SRS-22 scores in Chinese female patients with adolescent idiopathic scoliosis: does curve pattern matter? Br J Neurosurg 2024; 38:349-355. [PMID: 33491493 DOI: 10.1080/02688697.2021.1875396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 06/16/2020] [Accepted: 01/08/2021] [Indexed: 10/22/2022]
Abstract
Background: The Scoliosis Research Society (SRS)-22 outcomes have been shown to be correlated with radiographic parameter of adolescent idiopathic scoliosis (AIS). A recent study suggested that curve patterns might play a role in assessing the influence of deformity on patient's reported outcomes. The aim of this study was to examine the relationship between radiographic parameters and SRS-22 questionnaire outcomes in female patients with adolescent AIS among the Chinese population based on five curve patterns.Patients and Methods: The radiographic data and SRS-22 questionnaires of 259 female AIS patients were reviewed. Radiographic measurements included: Cobb angle of the major curve, T1 tilt angle, apical vertebral rotation, apical vertebral translation (AVT), thoracic kyphosis, and lumbar lordosis. Curve patterns included single thoracic (T), single thoracolumbar/lumbar (TL), double thoracic (DT), double major (DM), and triple major (TM). The correlation between radiographic measurements and each domain in SRS-22 was determined by Pearson's correlation coefficient.Results: The curve magnitude and AVT of the major curve were found to be significantly correlated with the self-image domain in all cases (Cobb angle: r = -0.426, p = 0.002; AVT: r = -0.281, p=0.006) and in all curve patterns except for TM. Compared to other groups, the TM group had a significantly larger major curve than the DT group and TL group (p ≤ 0.004). In TM group, the self-image scores were lower than TL group (p =0.018), and the function scores were lower than that in T, TL (p < 0.001) and DM groups (p =0.013). In the DT group, the T1 tilt was significantly correlated with the self-image domain (r = -0.376, p =0.004). In the T group, coronal curve magnitude was significantly correlated with function domain (r = -0.397, p < 0.001).Conclusion: Our findings suggested curve patterns should be considered in evaluating the correlations between radiographic parameters and SRS-22 outcomes in patients with AIS.
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Affiliation(s)
- Jie Li
- Department of Spine Surgery, Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Changchun Tseng
- Department of Spine Surgery, Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Yiwen Yuan
- Department of Spine Surgery, Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Dengxu Jiang
- Department of Spine Surgery, Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Zhikai Qian
- Department of Spine Surgery, Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Zongshan Hu
- Department of Spine Surgery, Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Zezhang Zhu
- Department of Spine Surgery, Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Yong Qiu
- Department of Spine Surgery, Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Zhen Liu
- Department of Spine Surgery, Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
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Dunn CL, Burjonrappa S. Pediatric Peripheral Vascular Trauma: Incidence and Outcomes. Am Surg 2024:31348241241623. [PMID: 38525516 DOI: 10.1177/00031348241241623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
Peripheral vascular trauma (PVT) is rare in children, with an incidence estimated below 1%. We studied pediatric PVT and risk factors for major amputation by accessing the 2019 National Trauma Data Bank (NTDB). Demographics, injury type and location, trauma center capability, injury severity score (ISS), length of stay (LOS), and major amputation rates were evaluated. Statistical analysis included chi-square testing for categorical variables and t-tests for continuous variables. Of 130,554 pediatric trauma patients, 1196 (.9%) had 1460 upper extremity (UE) and lower extremity (LE) PVT. Patients were predominantly male (n = 933, 78%) with a mean age of 14 years. Most patients suffered penetrating injury (n = 744, 62.2%). The most common vessels injuries were radial (n = 198, 13.6%) and femoral (n = 196, 13.4%). Major amputation occurred in 2.6% of patients (n = 31). Patients who suffered blunt injury (OR, 3.3; 95% CI, 1.5-7.5; P = .004) and lower limb PVT (OR, 11.1; 95% CI, 3.3-37.9, P = .0001) had higher odds of amputation.
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Affiliation(s)
- Candice L Dunn
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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Jamjoom FZ, Al-Barrak N, Al-Shehri H, Kiran Chitumalla R, Ul-Haq I. Level of evidence analysis of the Saudi Dental Journal: A bibliometric analysis of publications from 2012 to 2021. Saudi Dent J 2023; 35:812-818. [PMID: 38025592 PMCID: PMC10658367 DOI: 10.1016/j.sdentj.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 06/16/2023] [Accepted: 06/17/2023] [Indexed: 12/01/2023] Open
Abstract
Objectives The Level of Evidence (LOE) ranking system is used to measure the methodological quality of research. This study aimed to analyze and evaluate the trends of LOEs in articles published in the Saudi Dental Journal (SDJ) between 2012 and 2021. Methodology The bibliometric details of all articles published from 2012 to 2021 were extracted from the SDJ website. All articles, expect editorials, were included in the analysis. The articles were divided based on LOEs, dental specialties, number of authors, and centers. The citation metrics were obtained from Google Scholar, and the statistical analysis was performed using JMP Pro 15.2.0 software. Results Five hundred twenty-two articles were selected for analysis. They had an average of 21.19 citations per article, and a growing trend in the number of articles was observed. Authors from 40 countries contributed to the articles, with the most contributions from the Kingdom of Saudi Arabia. Most articles (n = 269; 51.53%) were LOE IV and V, while a low proportion (5.56%) were LOE I articles. Aside from miscellaneous articles, periodontics composed most of the LOE I studies, followed by endodontics, and oral and maxillofacial Surgery (OMFS). Orthodontics had the highest number of LOE II studies, pediatric dentistry had the most LOE IV, and prosthodontics had the most LOE V studies. No significant correlations were found between LOE and the number of authors or centers. However, a significant correlation was found in the distribution of LOE contributed by academic institutes. Conclusion The study results highlight that most articles were LOE IV and V, whereas nominal LOE I articles were found. Furthermore, there is a need to encourage dental scientists to carry out high-quality evidence studies. Professional dental societies can play a pivotal role in this regard.
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Affiliation(s)
- Faris Z. Jamjoom
- Restorative and Prosthetic Dental Science Department, College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Nasibah Al-Barrak
- King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Hanan Al-Shehri
- King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Raj Kiran Chitumalla
- Restorative and Prosthetic Dental Science Department, College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Ikram Ul-Haq
- King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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Gonzato O, Schuster K. The role of patient advocates and sarcoma community initiatives in musculoskeletal oncology. Moving towards Evidence-Based Advocacy to empower Evidence-Based Medicine. J Cancer Policy 2023; 36:100413. [PMID: 36806641 DOI: 10.1016/j.jcpo.2023.100413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 01/29/2023] [Accepted: 02/16/2023] [Indexed: 02/19/2023]
Abstract
Musculoskeletal sarcomas are rare cancers that as the whole family of sarcomas pose several challenges at different levels, ranging from medical knowledge to clinical research and policymaking. Addressing these challenges, necessarily calls for the inclusion of patient perspective inside the decision-making processes of every area that contributes to treatment improvement, from the provision of high-quality services by healthcare organisations to research issues. Without patient-provided inputs to inform decisions, the current paradigm of patient-centred care makes no sense and sounds at the least irrational if not unethical. Putting PROMs on "centre stage" in cancer research and care, could allow to build a truly Evidence Based Advocacy (EBA) and therefore to empower Evidence Based Medicine (EBM).
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Affiliation(s)
- Ornella Gonzato
- Fondazione Paola Gonzato-Rete Sarcoma ETS, Italy; Sarcoma Patient Advocacy Global Network (SPAGN), Germany.
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Mathes T, Mann NK, Thürmann P, Sönnichsen A, Pieper D. Assessing the quality of evidence on safety: specifications for application and suggestions for adaptions of the GRADE-criteria in the context of preparing a list of potentially inappropriate medications for older adults. BMC Med Res Methodol 2022; 22:234. [PMID: 36042413 PMCID: PMC9426023 DOI: 10.1186/s12874-022-01715-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 08/23/2022] [Indexed: 11/27/2022] Open
Abstract
Background Systematic reviews that synthesize safety outcomes pose challenges (e.g. rare events), which raise questions for grading the strength of the body of evidence. This is maybe one reason why in many potentially inappropriate medication (PIM) lists the recommendations are not based on formalized systems for assessing the quality of the body of evidence such as GRADE. In this contribution, we describe specifications and suggest adaptions of the GRADE system for grading the quality of evidence on safety outcomes, which were developed in the context of preparing a PIM-list, namely PRISCUS. Methods We systematically assessed each of the five GRADE domains for rating-down (study limitations, imprecision, inconsistency, indirectness, publication bias) and the criteria for rating-up, considering if special considerations or revisions of the original approach were indicated. The result was gathered in a written document and discussed in a group-meeting of five members with various background until consensus. Subsequently, we performed a proof-of-concept application using a convenience sample of systematic reviews and applied the approach to systematic reviews on 19 different clinical questions. Results We describe specifications and suggest adaptions for the criteria “study limitations”, imprecision, “publication bias” and “rating-up for large effect”. In addition, we suggest a new criterion to account for data from subgroup-analyses. The proof-of-concept application did not reveal a need for further revision and thus we used the approach for the systematic reviews that were prepared for the PRISCUS-list. We assessed 51 outcomes. Each of the proposed adaptions was applied. There were neither an excessive number of low and very low ratings, nor an excessive number of high ratings, but the different methodological quality of the safety outcomes appeared to be well reflected. Conclusion The suggestions appear to have the potential to overcome some of the challenges when grading the methodological quality of harms and thus may be helpful for producers of evidence syntheses considering safety. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-022-01715-5.
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Affiliation(s)
- Tim Mathes
- Department of Clinical Pharmacology, School of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany. .,Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany. .,Institute for Research in Operative Medicine, School of Medicine, Faculty of Health, Witten/Herdecke University, Cologne, Germany.
| | - Nina-Kristin Mann
- Department of Clinical Pharmacology, School of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Petra Thürmann
- Department of Clinical Pharmacology, School of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany.,Philipp Klee-Institute for Clinical Pharmacology, Helios University Hospital Wuppertal, Wuppertal, Germany
| | | | - Dawid Pieper
- Department of Clinical Pharmacology, School of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany.,Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Institute for Health Services and Health System Research, Neuruppin, Germany.,Center for Health Services Research, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
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9
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Keil LG, Mullis BH, Iii PT, Alley MC, Olszewski NP, Wheeler JA, von Kaeppler EP, Morshed S, Matar RN, Archdeacon MT, Smith TW, Miller AN, Horwitz DS, Baig MS, Telgheder ZL, Azer E, Manzano GW, Vallier HA, Barnett SA, Krause PC, Bornes TD, Ricci WM, Dunne PJ, Yarboro SR, Ment AJ, Marcantonio AJ, Alqudhaya RS, Leighton RK, Ostrum RF. Proximal tibia fracture dislocations: Management and outcomes of a severe and under-recognized injury. Injury 2022; 53:1260-1267. [PMID: 34602250 DOI: 10.1016/j.injury.2021.09.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 08/05/2021] [Accepted: 09/17/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Proximal tibia fracture dislocations (PTFDs) are a subset of plateau fractures with little in the literature since description by Hohl (1967) and classification by Moore (1981). We sought to evaluate reliability in diagnosis of fracture-dislocations by traumatologists and to compare their outcomes with bicondylar tibial plateau fractures (BTPFs). METHODS This was a retrospective cohort study at 14 level 1 trauma centers throughout North America. In all, 4771 proximal tibia fractures were reviewed by all sites and 278 possible PTFDs were identified using the Moore classification. These were reviewed by an adjudication board of three traumatologists to obtain consensus. Outcomes included inter-rater reliability of PTFD diagnosis, wound complications, malunion, range of motion (ROM), and knee pain limiting function. These were compared to BTPF data from a previous study. RESULTS Of 278 submitted cases, 187 were deemed PTFDs representing 4% of all proximal tibia fractures reviewed and 67% of those submitted. Inter-rater agreement by the adjudication board was good (83%). Sixty-one PTFDs (33%) were unicondylar. Eleven (6%) had ligamentous repair and 72 (39%) had meniscal repair. Two required vascular repair. Infection was more common among PTFDs than BTPFs (14% vs 9%, p = 0.038). Malunion occurred in 25% of PTFDs. ROM was worse among PTFDs, although likely not clinically significant. Knee pain limited function at final follow-up in 24% of both cohorts. CONCLUSIONS PTFDs represent 4% of proximal tibia fractures. They are often unicondylar and may go unrecognized. Malunion is common, and PTFD outcomes may be worse than bicondylar fractures.
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Affiliation(s)
- Lukas G Keil
- Departmentof Orthopaedic Surgery, University of North Carolina, Chapel Hill, NC, United States.
| | - Brian H Mullis
- Indiana University Department of Orthopaedics, Indianapolis, IN
| | - Paul Tornetta Iii
- Department of Orthopaedic Surgery, Boston University Medical Center, Boston, MA, United States
| | - Maxwell C Alley
- Department of Orthopaedic Surgery, Boston University Medical Center, Boston, MA, United States
| | - Nathan P Olszewski
- Department of Orthopaedic Surgery, Boston University Medical Center, Boston, MA, United States
| | | | - Ericka P von Kaeppler
- Department of Orthopaedic Surgery, University of San Francisco, California, San Francisco, CA, United States
| | - Saam Morshed
- Department of Orthopaedic Surgery, University of San Francisco, California, San Francisco, CA, United States
| | - Robert N Matar
- Department of Orthopaedics & Sports Medicine, University of Cincinnati Medical Center, Cincinnati, OH
| | - Michael T Archdeacon
- Department of Orthopaedics & Sports Medicine, University of Cincinnati Medical Center, Cincinnati, OH
| | - Tyler W Smith
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, United States
| | - Anna N Miller
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, United States
| | - Daniel S Horwitz
- Department of Orthopaedic Surgery, Geisinger Health System, Danville, PA, United States
| | - Mirza Shahid Baig
- Department of Orthopaedic Surgery, Geisinger Health System, Danville, PA, United States
| | | | - Emil Azer
- SUNY Upstate Medical University, Syracuse, NY, United States
| | - Givenchy W Manzano
- Department of Orthopaedic Surgery, MetroHealth Medical Center, affiliated with Case Western Reserve University, Cleveland, OH, United States
| | - Heather A Vallier
- Department of Orthopaedic Surgery, MetroHealth Medical Center, affiliated with Case Western Reserve University, Cleveland, OH, United States
| | - Scott A Barnett
- Department of Orthopaedic Surgery, Louisiana State University, New Orleans, LA, United States
| | - Peter C Krause
- Department of Orthopaedic Surgery, Louisiana State University, New Orleans, LA, United States
| | - Troy D Bornes
- Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, United States
| | - William M Ricci
- Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, United States
| | - Patrick J Dunne
- Department of Orthopaedics, University of Virginia, Charlottesville, VA, United States
| | - Seth R Yarboro
- Department of Orthopaedics, University of Virginia, Charlottesville, VA, United States
| | - Alexander J Ment
- Department of Orthopaedic Surgery, Lahey Hospital and Medical Center, Burlington, MA, United States
| | - Andrew J Marcantonio
- Department of Orthopaedic Surgery, Lahey Hospital and Medical Center, Burlington, MA, United States
| | | | - Ross K Leighton
- Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada
| | - Robert F Ostrum
- Departmentof Orthopaedic Surgery, University of North Carolina, Chapel Hill, NC, United States
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Shilati FM, Raval MV, Lautz TB. Technical factors and outcomes in pediatric central venous port placement. J Pediatr Surg 2022; 57:450-3. [PMID: 33752914 DOI: 10.1016/j.jpedsurg.2021.02.055] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/09/2021] [Accepted: 02/16/2021] [Indexed: 11/22/2022]
Abstract
Purpose While central venous port placement is common, there remains variation in placement technique and rates of technical complications. The aim of this study was to assess variability in techniques and identify predictors of complications for children undergoing port placement. Methods We retrospectively reviewed all 331 patients who underwent venous port placement at a single tertiary children's hospital from May 2018 to June 2020. The primary outcome was early revision or replacement (R/R) for complications occurring within 30 days. Secondary outcomes included radiation exposure and rate of intraoperative conversion to a secondary site. Results The median age was 7 years (Interquartile Range 3-13 years) and the most common diagnoses were leukemia (30.2%), solid tumors (27.8%), and brain tumors (16.9%). Initial approach for port placement was ultrasound-guided internal jugular (IJV) in 255 (147 by surgery and 108 by interventional radiology [IR]) and landmark subclavian vein (SCV) in 76 (all by surgery). Early R/R occurred in 5.1%, including 9.0% of patients with leukemia but 1.1% with solid tumors. Individual proceduralist volume ranged from 2 to 98 cases and was inversely correlated with early R/R (r = -0.12, p = 0.30). In univariate analysis, ports placed by IR had an increased rate of early R/R (9.3%, n = 10) compared to those placed by surgery (3.2%, n = 7, p = 0.036) but this was not significant in multivariable regression controlling for diagnosis and age (Hazard Ratio 2.04; p = 0.19). Mean fluoroscopy time was significantly longer for ports placed by IR (59.9 s) compared to those placed by surgery (15.1 s, p < 0.001). Initial SCV access was associated with an increased (14.5 vs 0.4%) rate of conversion to a secondary site. Conclusions Though venous port placement is a largely safe procedure in children, a substantial minority of patients, particularly those with leukemia, require early R/R. Proceduralist volume and training may influence early R/R, fluoroscopy exposure, and anatomic site preferences.
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Reppucci ML, Pickett K, Stevens J, Phillips R, Recicar J, Annen K, Moulton SL. Massive transfusion in pediatric trauma-does more blood predict mortality? J Pediatr Surg 2022; 57:308-313. [PMID: 34736771 DOI: 10.1016/j.jpedsurg.2021.09.051] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 09/27/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Treatment of severe hemorrhage focuses on the control of bleeding and intravascular volume expansion through massive transfusion (MT). This study aimed to determine if transfusion volumes in pediatric trauma patients who receive MT is associated with increased risk of death, and to establish if there is a threshold above which further resuscitation with blood products is futile. METHODS Pediatric patients (2-18 years old) in the 2014-2017 Trauma Quality Improvement Program (TQIP) database with complete age and blood transfusion data who met the MT definition of 40 mL/kg/24 h were included in analysis. Data elements were cleaned to eliminate discrepancies in reporting blood volumes and erroneous values were excluded. Early mortality was defined as death within 24 h. Late mortality was defined as death more than 24 h after hospital admission. Area under the curve (AUC) was calculated from receiver operating characteristic (ROC) curve analyses to determine upper volume thresholds to predict early versus late mortality. RESULTS There were 633 patients who met the MT definition of 40 mL/kg/24 h. The overall mortality rate was 21.6%. Volume of blood had poor predicting early and late mortality with an AUC of 0.50 [95% CI (0.42, 0.59)] and 0.50 [95% CI (0.43,0.57)], respectively. Regardless of mechanism, no transfusion volume was associated with a predictably high rate of mortality. CONCLUSIONS There is no upper transfusion volume threshold to predict mortality in pediatric trauma patients who are massively transfused, regardless of mechanism. Severely injured children can tolerate massive amounts of blood products and still survive. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Marina L Reppucci
- Division of Pediatric Surgery, Children's Hospital Colorado, 13123 E 16th Ave, Box 323, Anschutz Medical Campus, Aurora, CO 80045, USA; Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Kaci Pickett
- The Center for Research in Outcomes for Children's Surgery, Center for Children's Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jenny Stevens
- Division of Pediatric Surgery, Children's Hospital Colorado, 13123 E 16th Ave, Box 323, Anschutz Medical Campus, Aurora, CO 80045, USA; Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Ryan Phillips
- Division of Pediatric Surgery, Children's Hospital Colorado, 13123 E 16th Ave, Box 323, Anschutz Medical Campus, Aurora, CO 80045, USA
| | - John Recicar
- Division of Pediatric Surgery, Children's Hospital Colorado, 13123 E 16th Ave, Box 323, Anschutz Medical Campus, Aurora, CO 80045, USA; Division of Nursing, Children's Hospital Colorado, Aurora, CO, USA
| | - Kyle Annen
- Department of Pathology, Children's Hospital of Colorado, Aurora, CO, USA
| | - Steven L Moulton
- Division of Pediatric Surgery, Children's Hospital Colorado, 13123 E 16th Ave, Box 323, Anschutz Medical Campus, Aurora, CO 80045, USA; Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
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Hatami N, Shahravan A, Rouzpeykar M, Nekouei AH, Sharifi M. Evaluation of the Levels of Evidence in Three Clinical Chapters in Five Editions of the Textbook Pathways of the Pulp. Iran Endod J 2022; 17:121-125. [PMID: 36704090 PMCID: PMC9869007 DOI: 10.22037/iej.v17i3.37827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 06/09/2022] [Accepted: 07/06/2022] [Indexed: 01/28/2023]
Abstract
Introduction The levels of evidence (LOE) of dental education texts is critical from the educational point of view. The present study aimed to evaluate the levels of evidence of references used in three clinical chapters in the textbook Pathways of the Pulp. Material & Method The references of three clinical chapters in the text book Pathways of the Pulp were assessed in five of its editions. The levels of evidence were ranked according to study type and the Oxford scale from 0 to 5. The chi-square test was used to compare the level of evidence between different editions of the "Retreatment," "Trauma," and "Surgery" chapters. Results A total of 3656 references were reviewed and analyzed from the "Trauma" (928 references), "Re-treatment" (1906 references), and "Surgery" (822 references) chapters in the 1998, 2002, 2006, 2011, and 2016 editions. The percentage of the LOE 0 (no evidence) was high (>60%) in all three chapters in all editions (P<0.001). The levels of evidence had the same distribution in all editions (P=0.871). The LOE of the "Re-treatment" (P=0.044) and "Surgery" (P<0.001) chapters changed in some editions. Conclusion The majority of references in the three clinical chapters of the book are low-level evidence. Encouragement policies for researchers to conduct studies with high LOE are necessary.
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Affiliation(s)
- Nima Hatami
- Endodontology Research Center, Kerman University of Medical Sciences, Kerman, Iran;
| | - Arash Shahravan
- Endodontology Research Center, Kerman University of Medical Sciences, Kerman, Iran;
| | - Marzieh Rouzpeykar
- Kerman Dental School, Kerman University of Medical Sciences, Kerman, Iran;
| | - Amir Hossein Nekouei
- Department of Biostatistics and Epidemiology, School of Public Health, Kerman University of Medical Sciences, Kerman, Iran;
| | - Maryam Sharifi
- Pediatric Department of Kerman Dental school, Kerman University of Medical Sciences, Kerman, Iran,Corresponding author: Maryam Sharifi, Dentistry school, Kerman University of Medical Sciences, Kerman, Iran. Tel: +98-913 3974655, E-mail:
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Tamura R, O'Connor E, Jaffray B. Surgeon level variation in outcome of repair of congenital diaphragmatic hernia with particular reference to the management of recurrence. J Pediatr Surg 2021; 56:2207-2214. [PMID: 33775404 DOI: 10.1016/j.jpedsurg.2021.02.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 02/10/2021] [Accepted: 02/24/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The aim of this study is to investigate firstly, the rate of recurrence following primary repair of a congenital diaphragmatic hernia (CDH) and secondly, the rate of recurrence following revisional surgical repair. The primary outcome is rate of recurrence. Secondary outcomes are to establish whether recurrence is related to surgeon, surgeon volume, side of defect, the use of a patch, or a thoracopscopic approach METHODS: All repairs performed in an English regional center over 22 years were recorded. Possible explanatory variables were whether the repair was itself of a recurrence, the surgeon's identity, the surgeon's volume of prior repairs, the side of the defect, the use of a patch. RESULTS 198 repairs were performed; 170 primary repairs and 28 of recurrences. Failure occurred significantly more commonly among recurrences (32%) than primary repairs (11%), p = 0.005. Failure of the primary repair was significantly more common where a patch was used 8/34 (23%) rather than a sutured repair 10/136 (7%), p = 0.006, or where a thoracoscopic technique was used 4/13 (31%) rather than laparotomy 14/157 (9%) p = 0.01. Failure of the primary repair was unrelated to the identity of the surgeon (Χ2 = 5, p = 0.9) or the volume of prior repairs (t = 0.3, p = 0.6). However, failure of repair of a recurrence was significantly related to the surgeon's volume of prior repairs (t = 2.3, p = 0.01) and the identity of the surgeon (Χ2 = 17, p = 0.014), but not the use of a patch (Χ2 = 1.6, p = 0.2). CONCLUSIONS Repair of a recurrence of a CDH has a higher probability of failure than the original repair and is related to both the identity of the surgeon and the prior volume of experience. There is a volume outcome relationship for the repair of recurrence, but not the primary repair of CDH. Our study suggests the repair of recurrence of CDH should be restricted to surgeons with proven outcomes for this procedure.
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Affiliation(s)
- Ryo Tamura
- Department of Paediatric Surgery, The Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Elizabeth O'Connor
- Department of Paediatric Surgery, The Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Bruce Jaffray
- Department of Paediatric Surgery, The Great North Children's Hospital, Newcastle upon Tyne, UK.
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Svetanoff WJ, Zendejas B, Hernandez K, Davidson K, Ngo P, Manfredi M, Hamilton TE, Jennings R, Smithers CJ. Contemporary outcomes of the Foker process and evolution of treatment algorithms for long-gap esophageal atresia. J Pediatr Surg 2021; 56:2180-2191. [PMID: 33766420 DOI: 10.1016/j.jpedsurg.2021.02.054] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/03/2021] [Accepted: 02/19/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Esophageal growth using the Foker process (FP) for long-gap esophageal atresia (LGEA) has evolved over time. METHODS Contemporary LGEA patients treated from 2014-2020 were compared to historical controls (2005 to <2014). RESULTS 102 contemporary LGEA patients (type A 50%, B 18%, C 32%; 36% prior anastomotic attempt; 20 with esophagostomy) underwent either primary repair (n=23), jejunal interposition (JI; n = 14), or Foker process (FP; n = 65; 49 primary [p], 16 rescue [r]). The contemporary p-FP cohort experienced significantly fewer leaks on traction (4% vs 22%), bone fractures (2% vs 22%), anastomotic leak (12% vs 37%), and Foker failure (FP→JI; 0% vs 15%), when compared to historical p-FP patients (n = 27), all p ≤ 0.01. Patients who underwent a completely (n = 11) or partially (n = 11) minimally invasive FP experienced fewer median days paralyzed (0 vs 8 vs 17) and intubated (9 vs 15 vs 25) compared to open FP patients, respectively (all p ≤ 0.03), with equivalent leak rates (18% vs 9% vs 26%, p = 0.47). At one-year post-FP, most patients (62%) are predominantly orally fed. CONCLUSION With continued experience and technical refinements, the Foker process has evolved with improved outcomes, less morbidity and maximal esophageal preservation.
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Affiliation(s)
- Wendy Jo Svetanoff
- Boston Children's Hospital, Department of General Surgery; Children's Mercy Hospital, Department of Pediatric Surgery
| | | | - Kayla Hernandez
- Boston Children's Hospital, Department of Otolaryngology and Communication Enhancement
| | - Kathryn Davidson
- Boston Children's Hospital, Department of Otolaryngology and Communication Enhancement
| | - Peter Ngo
- Boston Children's Hospital, Division of Gastroenterology, Hepatology, and Nutrition
| | - Michael Manfredi
- Boston Children's Hospital, Division of Gastroenterology, Hepatology, and Nutrition
| | | | | | - C Jason Smithers
- Boston Children's Hospital, Department of General Surgery; Johns Hopkins All Children's Hospital, Department of Surgery
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Maassel NL, Shaughnessy MP, Solomon DG, Cowles RA. Trends in fundoplication volume for pediatric gastroesophageal reflux disease. J Pediatr Surg 2021; 56:1495-1499. [PMID: 33745746 DOI: 10.1016/j.jpedsurg.2021.02.045] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/10/2021] [Accepted: 02/19/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Fundoplication for gastro-esophageal reflux disease (GERD) has been commonly performed by pediatric surgeons, however there are no recent data documenting fundoplication trends. Changes in fundoplication volume impact pediatric surgical training and may reflect changes in care for children with severe GERD. MATERIALS & METHODS The Pediatric Health Information System (PHIS) was queried from 2010-2019 for children with ICD-9/ICD-10 codes for GERD, fundoplication, and gastrostomy. Institutional surgical volume and patient demographics were examined over time. A secondary analysis using the Accreditation Council for Graduate Medical Education case logs for pediatric surgery fellows was performed across the same years to assess effects upon surgical volume for trainees. RESULTS Mean institutional fundoplication case volume decreased from 50 in 2010 to 17 in 2019. Trends were similar between institutions with and without fellowship programs when corrected by total operative volume. Patient characteristics were relatively unchanged between 2010 and 2019. Fundoplication volume reported in fellow case logs decreased from 46 in 2010 to 26 in 2019, mirroring national data. CONCLUSIONS Institutional volume for fundoplication in children with GERD has seen a 3-fold decrease over the last decade, mirrored by an almost 2-fold decrease in case volume reported by pediatric surgery fellows.
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Affiliation(s)
- Nathan L Maassel
- Yale University School of Medicine, Department of Surgery, Division of Pediatric Surgery, New Haven, CT, USA
| | - Matthew P Shaughnessy
- Yale University School of Medicine, Department of Surgery, Division of Pediatric Surgery, New Haven, CT, USA
| | - Daniel G Solomon
- Yale University School of Medicine, Department of Surgery, Division of Pediatric Surgery, New Haven, CT, USA
| | - Robert A Cowles
- Yale University School of Medicine, Department of Surgery, Division of Pediatric Surgery, New Haven, CT, USA.
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Kawaguchi AL, Guner YS, Sømme S, Quesenberry AC, Arthur LG, Sola JE, Downard CD, Rentea RM, Valusek PA, Smith CA, Slidell MB, Ricca RL, Dasgupta R, Renaud E, Miniati D, McAteer J, Beres AL, Grabowski J, Peter SDS, Gosain A. Management and outcomes for long-segment Hirschsprung disease: A systematic review from the APSA Outcomes and Evidence Based Practice Committee. J Pediatr Surg 2021; 56:1513-1523. [PMID: 33993978 PMCID: PMC8552809 DOI: 10.1016/j.jpedsurg.2021.03.046] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 03/11/2021] [Accepted: 03/15/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Long-Segment Hirschsprung Disease (LSHD) differs clinically from short-segment disease. This review article critically appraises current literature on the definition, management, outcomes, and novel therapies for patients with LSHD. METHODS Four questions regarding the definition, management, and outcomes of patients with LSHD were generated. English-language articles published between 1990 and 2018 were compiled by searching PubMed, Scopus, Cochrane Central Register of Controlled Trials, Web of Science, and Google Scholar. A qualitative synthesis was performed. RESULTS 66 manuscripts were included in this systematic review. Standardized nomenclature and preoperative evaluation for LSHD are recommended. Insufficient evidence exists to recommend a single method for the surgical repair of LSHD. Patients with LSHD may have increased long-term gastrointestinal symptoms, including Hirschsprung-associated enterocolitis (HAEC), but have a quality of life similar to matched controls. There are few surgical technical innovations focused on this disorder. CONCLUSIONS A standardized definition of LSHD is recommended that emphasizes the precise anatomic location of aganglionosis. Prospective studies comparing operative options and long-term outcomes are needed. Translational approaches, such as stem cell therapy, may be promising in the future for the treatment of long-segment Hirschsprung disease.
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Affiliation(s)
- Akemi L Kawaguchi
- Department of Pediatric Surgery, University of Texas Health Science Center at Houston, Houston, TX, USA.
| | - Yigit S Guner
- Department of Surgery University of California Irvine and Division of Pediatric Surgery Children's Hospital of Orange County, USA
| | - Stig Sømme
- Division of Pediatric Surgery, Children's Hospital Colorado, University of Colorado, Aurora, CO, USA
| | | | - L Grier Arthur
- Division of Pediatric General, Thoracic, and Minimally Invasive Surgery, St. Christopher's Hospital for Children, Philadelphia, PA, USA
| | - Juan E Sola
- Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Cynthia D Downard
- Division of Pediatric Surgery, Hiram C. Polk, Jr, MD Department of Surgery, University of Louisville, Louisville, KY, USA
| | - Rebecca M Rentea
- Department of Pediatric Surgery, Children's Mercy-Kansas City, Kansas City, MO, USA
| | - Patricia A Valusek
- Pediatric Surgical Associates, Children's Minnesota, Minneapolis, MN, USA
| | - Caitlin A Smith
- Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
| | - Mark B Slidell
- Section of Pediatric Surgery, Comer Children's Hospital, The University of Chicago Medicine, Chicago, Illinois, USA
| | - Robert L Ricca
- Division of Pediatric Surgery, Naval Medical Center, Portsmouth, VA, USA
| | - Roshni Dasgupta
- Division of Pediatric General and Thoracic Surgery, Cincinnati Childrens Medical Center, University of Cincinnati, Cincinnati OH, USA
| | - Elizabeth Renaud
- Division of Pediatric Surgery, Alpert Medical School of Brown University, Hasbro Children's Hospital, Rhode Island Hospital, Providence, RI, USA
| | - Doug Miniati
- Division of Pediatric Surgery, Kaiser Permanente Roseville Women and Children's Center, Roseville, California, USA
| | | | - Alana L Beres
- Division of Pediatric General, Thoracic and Fetal Surgery, University of California, Davis, Sacramento CA, USA
| | - Julia Grabowski
- Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital, Northwestern University, Chicago, IL long, USA
| | - Shawn D St Peter
- Department of Surgery, Children's Mercy Hospital, Kansas City, MO, USA
| | - Ankush Gosain
- Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Children's Foundation Research Institute, Le Bonheur Children's Hospital, Memphis, TN, USA.
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Abstract
PURPOSE On-The-Go (OTG) references are those that clinicians make within a tight deadline at the point of patient care to direct critical decisions. We conducted this study to assess the knowledge level of orthopaedicians on clinical usefulness and quality appraisal of different reference methods along with their attitude towards its utility for practice. MATERIALS AND METHODS A web-based survey was administered through Google Forms among the members of the Tamil Nadu Orthopaedic Association (TNOA) by snowball sampling method. The survey was designed by the Quality Appraisal Committee (QAC) of Orthopaedic Research Group (ORG) with 17 items. Association and correlation analysis were done between different responses in the survey to find out ways to improve the reference practices. RESULTS 177 participants with a mean age of 43.5 years completed the survey. About 45.8% (n = 81) of participants had prior knowledge on the Oxford Levels of Evidence. However, they were not familiar with using them for critical appraisal of evidence. About 86.5% (n = 153) of participants were worried about the quality of the content they seek for reference. Among the reference sources, online research articles were used by 54.2% (n = 96), digital applications by 21.4% (n = 38), digital textbooks by 15.2% (n = 27), and other methods like peer discussion by 5.1% (n = 9). A significant association was noted between the participants who chose level I studies for their reference and their familiarity with the concept of fragility (p = 0.006) and heterogenicity (p = 0.021) and types of bias (p = 0.003). A significant association was noted between participants with active journal subscription and their familiarity with the concept of spin (p = 0.016) and their knowledge of the heterogeneity of study results (p = 0.019). We found a significant association between age (< 40 years of age) and knowledge on various types of bias (p = 0.032), heterogenicity (p = 0.01), and fragility (p = 0.021). CONCLUSION This is the first study on the information-seeking behaviour of the orthopaedicians. OTG references remain a part of the orthopaedic practice and are made mostly by accessing online research articles. Imparting knowledge of their quality appraisal should be an active part of the orthopaedic curriculum. This will, in turn, improve the attitude and reference practices leading to better decision-making towards patient care.
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Affiliation(s)
| | - Muthu Sathish
- Orthopaedic Research Group, Coimbatore, Tamil Nadu India
- Government Hospital, Velayuthampalayam, Karur, Tamil Nadu India
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Huang J, Shen H, Wu J, Hu X, Zhu Z, Lv X, Liu Y, Wang Y. Spine Explorer: a deep learning based fully automated program for efficient and reliable quantifications of the vertebrae and discs on sagittal lumbar spine MR images. Spine J 2020; 20:590-599. [PMID: 31759132 DOI: 10.1016/j.spinee.2019.11.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 11/17/2019] [Accepted: 11/18/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Although quantitative measurements improve the assessment of disc degeneration, acquirement of quantitative measurements relies on manual segmentation on lumbar magnetic resonance images (MRIs), which may introduce subjective bias. To date, only a few semiautomatic systems have been developed to quantify important components on MRIs. PURPOSE To develop a deep learning based program (Spine Explorer) for automated segmentation and quantification of the vertebrae and intervertebral discs on lumbar spine MRIs. STUDY DESIGN Cross-sectional study. PATIENT SAMPLE The study was extended on the Hangzhou Lumbar Spine Study, a population-based study of mainland Chinese with focuses on lumbar degenerative changes. From this population-based database, 50 sets lumbar MRIs were randomly selected as training dataset, and another 50 as test dataset. OUTCOME MEASURES Regions of vertebrae and discs were manually segmented on T2W sagittal MRIs to train a convolutional neural network for automated segmentation. Intersection-over-union was calculated to evaluate segmentation performance. Computational definitions were proposed to acquire quantitative morphometric and signal measurements for lumbar vertebrae and discs. MRIs in the test dataset were automatically measured with Spine Explorer and manually with ImageJ. METHODS Intraclass correlation coefficient (ICC) were calculated to examine inter-software agreements. Correlations between disc measurements and Pfirrmann score as well as age were examined to assess measurement validity. RESULTS The trained Spine Explorer automatically segments and measures a lumbar MRI in half a second, with mean Intersection-over-union of 94.7% and 92.6% for the vertebra and disc, respectively. For both vertebra and disc measurements acquired with Spine Explorer and ImageJ, the agreements were excellent (ICC=0.81~1.00). Disc measurements significantly correlated to Pfirrmann score, and greater age was associated with greater anterior disc bulging area (r=0.35~0.44) and fewer signal measurements (r=-0.62~-0.77) as automatically acquired with Spine Explorer. CONCLUSIONS Spine Explorer is an efficient, accurate, and reliable tool to acquire comprehensive quantitative measurements for lumbar vertebra and disc. Implication of such deep learning based program can facilitate clinical studies of the lumbar spine.
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Affiliation(s)
- Jiawei Huang
- Spine Lab, Department of Orthopedic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, The Second Floor of Building 3, 79# Qingchun Road, Hangzhou 310003, China
| | - Haotian Shen
- Spine Lab, Department of Orthopedic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, The Second Floor of Building 3, 79# Qingchun Road, Hangzhou 310003, China
| | - Jialong Wu
- Spine Lab, Department of Orthopedic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, The Second Floor of Building 3, 79# Qingchun Road, Hangzhou 310003, China
| | - Xiaojian Hu
- Spine Lab, Department of Orthopedic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, The Second Floor of Building 3, 79# Qingchun Road, Hangzhou 310003, China
| | - Zhiwei Zhu
- Department of Radiology, Dongyang People's Hospital, Dongyang, China
| | - Xiaoqiang Lv
- Department of Orthopedic Surgery, Dongyang People's Hospital, Dongyang, China
| | - Yong Liu
- Department of Control Science, Institute of Cyber-Systems and Control, Zhejiang University, Hangzhou 310027, China.
| | - Yue Wang
- Spine Lab, Department of Orthopedic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, The Second Floor of Building 3, 79# Qingchun Road, Hangzhou 310003, China.
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Singhavi H, Ahluwalia JS, Stepanov I, Gupta PC, Gota V, Chaturvedi P, Khariwala SS. Tobacco carcinogen research to aid understanding of cancer risk and influence policy. Laryngoscope Investig Otolaryngol 2018; 3:372-376. [PMID: 30450409 PMCID: PMC6209619 DOI: 10.1002/lio2.204] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 07/03/2018] [Indexed: 12/11/2022] Open
Abstract
Education regarding the health effects associated with tobacco use has made important progress worldwide over the last few decades. Still, tobacco remains a significant cause of cancer and other diseases. As a result, significant worldwide morbidity and mortality is still attributable to tobacco use in modern times. Research into tobacco products, the carcinogens they contain, and how users metabolize them is an important benefit to the advancement of research aimed at reducing harm associated with tobacco use. This review summarizes the use of this type of research to study tobacco users’ risk of developing cancer, especially head and neck cancer. In addition, we discuss the use of tobacco research to provide support for increasing levels of federal regulation of tobacco products. Level of Evidence 4.
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Affiliation(s)
| | - Jasjit S Ahluwalia
- The School of Public Health Brown University Providence Rhode Island U.S.A
| | | | - Prakash C Gupta
- Healis-Sekhsaria Institute for Public Health Minneapolis Minnesota U.S.A
| | | | | | - Samir S Khariwala
- Department of Otolaryngology-Head and Neck Surgery University of Minnesota Minneapolis Minnesota U.S.A
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Fayaz HC, Jupiter JB. The Zeitgeist of Challenging the Evidence. A Perspective on the International Consensus Meeting on Periprosthetic Joint Infection. Arch Bone Jt Surg 2017; 5:32-38. [PMID: 28271085 PMCID: PMC5339353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 06/05/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND The economic burden of the treatment of periprosthetic joint infection (PJI) is high and the treatment of PJI has a high degree of international controversy. Several papers have declared the International Consensus Meeting on Periprosthetic Joint Infection (ICMPJI) to be the "flawless pledge of international academics" to overcome the challenges of musculoskeletal infections. The purpose of this paper is to highlight for the first time some essential insights into the key dilemmas that are associated with this international consensus process. METHODS The proceedings of the ICMPJI was reviewed, and the critical consensus agreements that were reached were communicated via e-mail to 48 leading orthopaedic surgeons, microbiologists and statisticians around the world. Of these, 30 responded, 8 did not, and 10 of respondents were not aware of the ICMPJI. RESULTS A thorough review of the ICMPJI proceedings identified a clear need to resolve some of the dilemmas that we highlight in this paper. The Delphi procedure has been described as a survey technique that enables a group dynamic-based practice. Although there have been several published reports on this procedure, its scientific merit is still being debated. Several challenges and questions have been raised regarding the application of the Delphi technique, but there is no doubt that it is a vital approach for achieving consensus on subjects where none currently exists. CONCLUSION Performing prospective clinical studies in this area is currently the best and only option to overcome this challenge. In the long term, this approach will not only incorporate the standard of clinical evidence but also adopt regional mores for treating infection, which include patient values, cultural differences and local financial resources.
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Affiliation(s)
- Hangama C Fayaz
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Jesse B Jupiter
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
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Schneekloth BJ, Lowery NJ, Wukich DK. Charcot Neuroarthropathy in Patients With Diabetes: An Updated Systematic Review of Surgical Management. J Foot Ankle Surg 2016; 55:586-90. [PMID: 26810129 DOI: 10.1053/j.jfas.2015.12.001] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Indexed: 02/03/2023]
Abstract
Charcot neuroarthropathy (CN) of the foot and ankle is a demanding clinical dilemma, and surgical management can be very complicated. Historically, the evidence guiding surgical management of CN has been small retrospective case series and expert opinions. The purpose of the present report was to provide a systematic review of studies published from 2009 to 2014 and to review the indications for surgery. A Medline search was performed, and a systematic review of studies discussing the surgical management of CN was undertaken. Thirty reports fit the inclusion criteria for our study, including 860 patients who had undergone a surgical procedure for the treatment of CN. The surgical procedures included amputation, arthrodesis, debridement of ulcers, drainage of infections, and exostectomy. The midfoot was addressed in 26.9% of cases, the hindfoot in 41.6%, and the ankle in 38.4%. Of the 30 studies, 24 were retrospective case series (level 4), 4 were controlled retrospective studies (level 3), and 2 were level II studies. The overall amputation rate was 8.9%. The quality of the published data on the surgical management of CN has improved during the past several years. Evidence concerning the timing of treatment and the use of different fixation methods remains inconclusive.
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Affiliation(s)
- Brian J Schneekloth
- Podiatric Medicine and Surgery Residency Program, UPMC Mercy and University of Pittsburgh School of Medicine, Pittsburgh PA
| | - Nicholas J Lowery
- Podiatric Medicine and Surgery Residency Program, UPMC Mercy and University of Pittsburgh School of Medicine, Pittsburgh PA; Washington Health System Wound and Skin Healing Center and Hyperbaric Medicine, Washington, PA
| | - Dane K Wukich
- Professor of Orthopaedic Surgery, University of Pittsburgh School of Medicine. Medical Director, UPMC Mercy Center for Healing and Amputation Prevention, Pittsburgh, PA.
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