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Charles R, Hood B, DeRosier JM, Gosbee JW, Bagian JP, Li Y, Caird MS, Biermann JS, Hake ME. Root Cause Analysis and Actions for the Prevention of Medical Errors: Quality Improvement and Resident Education. Orthopedics 2017; 40:e628-e635. [PMID: 28437546 DOI: 10.3928/01477447-20170418-04] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2016] [Accepted: 03/07/2017] [Indexed: 02/03/2023]
Abstract
The quality of care delivered by orthopedic surgeons continues to grow in importance. Multiple orthopedic programs, organizations, and committees have been created to measure the quality of surgical care and reduce the incidence of medical adverse events. Structured root cause analysis and actions (RCA2) has become an area of interest. If performed thoroughly, RCA2 has been shown to reduce surgical errors across many subspecialties. The Accreditation Council for Graduate Medical Education has a new mandate for programs to involve residents in quality improvement processes. Resident engagement in the RCA2 process has the dual benefit of educating trainees in patient safety and producing meaningful changes to patient care that may not occur with traditional quality improvement initiatives. The RCA2 process described in this article can provide a model for the development of quality improvement programs. In this article, the authors discuss the history and methods of the RCA2 process, provide a stepwise approach, and give a case example. [Orthopedics. 2017; 40(4):e628-e635.].
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Hooper G. Improving outcomes in orthopaedic care. N Z Med J 2017; 130:10-11. [PMID: 28494473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Gary Hooper
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch
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Kandel L, Barzilay Y, Friedman A, Ilsar I, Safran O, Mattan Y. Informal (Hallway) medical consultation in orthopedics-is it as common as it seems? Arch Orthop Trauma Surg 2017; 137:607-610. [PMID: 28286926 DOI: 10.1007/s00402-017-2667-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 10/16/2016] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Informal (hallway) medical consultation is an integral part of the physician's work. As musculoskeletal complaints are very common, orthopedic surgeons stand in the frontline of this practice. Many of these consultations are poorly, if at all, documented, thus imposing a potential medical danger to the patient and a medicolegal danger to the surgeon. We conducted this first study to examine whether this practice is common among the orthopedic surgeons in university hospital. METHODS In this prospective study, a 2-month record of informal consultations was kept. Six orthopedic surgeons-two joint reconstruction surgeons, one spine surgeon, two arthroscopy and sports medicine surgeons, and a shoulder surgeon participated. They recorded the details of the consulter, whether the consultation was for himself or somebody else, the major complaint, and whether it was a second opinion. All patients were advised to go to the formal orthopedic consultation and no advice or treatment was given. At the end of 2 months, each surgeon was asked to evaluate the percentage of cases he had failed to report. RESULTS During the 2-month period, 158 people asked for informal (hallway) consultations. 11 of them (7%) were physicians, 114 (72%) were other hospital personnel, 26 (17%) were unrelated to hospital, and 6 (4%) were treated patients' relatives. 93 (59%) of consultations were about the consulter himself and the rest were about a relative or a friend. 41 (26%) were requests for a second opinion. The estimated percentage of not reported cases was 10-40%; when the number of consultations was corrected for these figures, it reached 208 consultations in 2 months. DISCUSSION In this prospective study, six participating surgeons recorded 158 informal consultation requests in 2 months. If a correction is performed, it averages 0.6 consultations a day for a surgeon (or, if only workdays are counted-0.8 consultations a day). Orthopedic surgeons should be aware of this frequent habit and send these patients to a formal consultation.
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Affiliation(s)
- Leonid Kandel
- Department of Orthopaedic Surgery, Hadassah-Hebrew University Medical Center, POB 23816, 91237, Jerusalem, Israel.
| | - Yair Barzilay
- Department of Orthopaedic Surgery, Shaarei Zedek Medical Center, Jerusalem, Israel
| | - Adi Friedman
- Department of Orthopaedic Surgery, Hadassah-Hebrew University Medical Center, POB 23816, 91237, Jerusalem, Israel
| | - Idan Ilsar
- Department of Orthopaedic Surgery, Hadassah-Hebrew University Medical Center, POB 23816, 91237, Jerusalem, Israel
| | - Ori Safran
- Department of Orthopaedic Surgery, Hadassah-Hebrew University Medical Center, POB 23816, 91237, Jerusalem, Israel
| | - Yoav Mattan
- Department of Orthopaedic Surgery, Hadassah-Hebrew University Medical Center, POB 23816, 91237, Jerusalem, Israel
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Rahbek O, Jensen SL, Lind M, Penny JØ, Kallemose T, Jakobsen T, Troelsen A. Inferior reliability of VAS scoring compared with International Society of the Knee reporting system for abstract assessment. Dan Med J 2017; 64:A5346. [PMID: 28385168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Knowledge of how abstracts may be se-lected for medical conferences in an efficient and reliable manner is sparse. To improve abstract selection, the Danish Orthopaedic Society implemented the International Society of the Knee (ISK) quality-of-reporting system and visual analogue scale (VAS) scoring for abstract evaluation at its 2014 Annual Congress. We sought to find out if a simple VAS score was more reliable than a multiple-question system for assessment of over-all abstract quality. METHODS A total of 214 abstracts were submitted for review. All abstracts were reviewed by 3 reviewers using a VAS score and the ISK score. Of the 214, 71 abstracts were reviewed again 6 months later to estimate intra-rater agreement. RESULTS The VAS and the ISK score were poorly correlated (r = 0.64), and the ISK score demonstrated a better intra- and interrater agreement (p < 0.001). The VAS scores of all abstracts were more widely distributed than the ISK scores, which clustered around values in the 50-70 range. Chronbach's alpha for the ISK score was 0.66 (95% confidence interval: 0.62-0.68). CONCLUSIONS The VAS score has a poorer intra- and interrater agreement than the ISK score, and the two scores do not correlate well. VAS scores were more widely distributed, which is beneficial when selecting a scientific programme, but the score is unreliable. We continue to use the ISK score, although its reliability may still be improved. FUNDING none. TRIAL REGISTRATION not relevant.
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Poosiripinyo T, Paholpak P, Jirarattanaphochai K, Kosuwon W, Sirichativapee W, Wisanuyotin T, Laupattarakasem P, Sukhonthamarn K, Jeeravipoolvarn P, Sakakibara T, Kasai Y. The Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ): A validation of the reliability of the Thai version. J Orthop Sci 2017; 22:34-37. [PMID: 27793440 DOI: 10.1016/j.jos.2016.10.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 09/06/2016] [Accepted: 10/04/2016] [Indexed: 02/09/2023]
Abstract
BACKGROUND The Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) was developed by the Japanese Orthopedic Association (JOA) for assessment of lower back pain and lumbar spinal disease. We aimed to translate the JOABPEQ into Thai and test its reliability and validity in the Thai context. METHODS The original JOABPEQ was translated into Thai in accordance with international recommendations. Then 180 lumbar spinal disease patients (mean age 58.58 ± 11.97, 68.3% female) were asked to complete the Thai version of the JOABPEQ twice at 2-week intervals. Test-retest reliability was analyzed using the intra-class correlation coefficient (ICC). Internal consistencies were analyzed using Cronbach's alpha, while the construct validity was compared with the Thai version of the modified SF-36, and tested using the Spearman's rank correlation coefficient. RESULTS The Thai JOABPEQ showed satisfactory test-retest reliability in all parameters (Intra-class Correlation Coefficient 0.761-0.862). The variables low back pain, walking ability, social life function, and mental health had satisfactory internal consistency (the respective Cronbach's α was 0.798, 0.721, 0.707, and 0.795). Only the lumbar function parameter showed moderate reliability (Cronbach's α = 0.654). All of the variables in the Thai JOABPEQ had a statistically positive correlation with the correspondent Thai SF-36 subscales (Spearman's rank correlation p value < 0.05). CONCLUSION The Thai version of JOABPEQ had satisfactory internal consistency, test-retest reliability, and construct validity; it can be used as a reliable tool for assessing quality of life for lumbar spinal disease patients in Thailand.
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Affiliation(s)
- Thanate Poosiripinyo
- Department of Orthopedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Permsak Paholpak
- Department of Orthopedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand.
| | - Kitti Jirarattanaphochai
- Department of Orthopedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Weerachai Kosuwon
- Department of Orthopedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Winai Sirichativapee
- Department of Orthopedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Taweechok Wisanuyotin
- Department of Orthopedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Pat Laupattarakasem
- Department of Orthopedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Kamolsak Sukhonthamarn
- Department of Orthopedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Polasak Jeeravipoolvarn
- Department of Orthopedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Toshihiko Sakakibara
- Department of Spinal Surgery and Biomedical Engineering, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Yuichi Kasai
- Department of Spinal Surgery and Biomedical Engineering, Mie University Graduate School of Medicine, Tsu, Mie, Japan
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Aksekili MAE, Aktekin L, Korkmazer S, Akyol M, Kılıçarslan K, Tosun N. The Japanese Orthopedic Association Back Pain Evaluation Questionnaire: A Turkish validation study. J Orthop Sci 2016; 21:718-722. [PMID: 27452738 DOI: 10.1016/j.jos.2016.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 06/05/2016] [Accepted: 06/29/2016] [Indexed: 02/09/2023]
Abstract
BACKGROUND The aim of this study was to apply cross-cultural adaptation and validity assessment to the Turkish translation of the Japanese Orthopedic Association Back Pain Evaluation Questionnaire applied to patients conservatively monitored for lumbar disc hernia and narrowing of the lumbar canal. METHODS The questionnaire was translated into Turkish based on guidelines. In respect of the comprehensibility of the obtained pre-final version of the questionnaire, a pilot test was applied to 20 healthy individuals. The patients were requested to complete the final version of the questionnaire after an orthopedic and physical therapy assistant doctor (resident) had completed the diagnosis and demographic information. To evaluate the retest reliability, the test was applied a second time, 14 days (±3 days) after the first application, again in the Orthopedics and Physical Therapy Outpatient Clinic. RESULTS The study was completed with a total of 215 individuals, comprising 107 patients and 108 healthy volunteers. When Turkish version of the questionnaire scale was evaluated of the patients and healthy volunteers together, the internal consistency was determined at the levels of Cronbach's α excellent. The lowest correlations of all the questionnaire scale items with the scale sub-dimensions was at the level of r = 0.509, which demonstrated that there was a sufficient validity level of the Turkish translated questionnaire scale. A statistically significant direct correlation at a high level was seen between the pre and post points in all the scale sub-dimensions. CONCLUSIONS The results of the current study showed that Turkish version of the questionnaire had sufficient reliability and validity in the evaluation of low back pain and resulting dysfunction and disability in patients with LDH and narrowing of the lumbar canal.
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Affiliation(s)
- Mehmet Atıf Erol Aksekili
- Yıldırım Beyazıt University School of Medicine, Atatürk Education and Research Hospital, Department of Orthopaedic Surgery, Ankara, Turkey.
| | - Lale Aktekin
- Yıldırım Beyazıt University, Atatürk Education and Research Hospital, Physical Therapy and Rehabilitation Clinic, Ankara, Turkey
| | - Selçuk Korkmazer
- Yıldırım Beyazıt University School of Medicine, Atatürk Education and Research Hospital, Department of Orthopaedic Surgery, Ankara, Turkey
| | - Mesut Akyol
- Yıldırım Beyazıt University, Department of Biostatistics, Ankara, Turkey
| | - Kasım Kılıçarslan
- Yıldırım Beyazıt University School of Medicine, Atatürk Education and Research Hospital, Department of Orthopaedic Surgery, Ankara, Turkey
| | - Nihat Tosun
- Yıldırım Beyazıt University School of Medicine, Atatürk Education and Research Hospital, Department of Orthopaedic Surgery, Ankara, Turkey
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Marks D, Comans T, Thomas M, Ng SK, O'Leary S, Conaghan PG, Scuffham PA, Bisset L. Agreement between a physiotherapist and an orthopaedic surgeon regarding management and prescription of corticosteroid injection for patients with shoulder pain. ACTA ACUST UNITED AC 2016; 26:216-222. [PMID: 27744222 DOI: 10.1016/j.math.2016.10.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 06/03/2016] [Revised: 09/29/2016] [Accepted: 10/01/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND Physiotherapists increasingly manage shoulder referrals in place of orthopaedic doctors. Better understanding the agreement between these professionals will help inform the safety, quality and potential costs of these care models. OBJECTIVE To establish the level of agreement between a physiotherapist and an orthopaedic surgeon regarding diagnosis, management and corticosteroid injection, in a representative sample of orthopaedic shoulder referrals. DESIGN Blinded inter-rater agreement study. METHOD 274 public orthopaedic shoulder patients were independently assessed by a physiotherapist and an orthopaedic surgeon. Management, subacromial corticosteroid injection, diagnosis and investigation decisions were compared using inter-rater reliability statistics. RESULTS Agreement between the physiotherapist and the orthopaedic surgeon was near perfect for surgical versus nonsurgical management (Gwets agreement coefficient AC1 = 0.93, 95%CI: 0.90-0.93), safety of injection (AC1 = 0.85, CI: 0.79-0.91) and investigations requested (AC1 = 0.87, CI: 0.83-0.91); substantial for the presence of subacromial pain (AC1 = 0.74, CI: 0.66-0.81) and diagnosis (AC1 = 0.72, CI: 0.66-0.78); and moderate regarding delivery of subacromial corticosteroid injection as an immediate treatment (AC1 = 0.48, CI 0.33-0.53), with the physiotherapist less inclined to select corticosteroid injection as the first intervention. CONCLUSION In this study a physiotherapist with prescribing and injection training made decisions analogous to those of an orthopaedic surgeon at initial consultation for orthopaedic shoulder pain, including the safe identification of patients for subacromial injection, without prior screening of referrals by orthopaedic doctors. TRIAL REGISTRATION Australia and New Zealand Clinical Trials Registry, number 12612000532808.
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Affiliation(s)
- Darryn Marks
- Gold Cost Hospital and Health Service, Gold Coast University Hospital, 1 Hospital Boulevard, Southport, 4215, Gold Coast, Australia; Menzies Health Institute Queensland, Griffith University, Parklands Drive Southport, QLD 4222, Gold Coast, Australia.
| | - Tracy Comans
- Menzies Health Institute Queensland, Griffith University, Parklands Drive Southport, QLD 4222, Gold Coast, Australia; Metro North Hospital and Health Service, 112 Alfred Street, Fortitude Valley, QLD 4006, Brisbane, Australia
| | - Michael Thomas
- Gold Cost Hospital and Health Service, Gold Coast University Hospital, 1 Hospital Boulevard, Southport, 4215, Gold Coast, Australia
| | - Shu Kay Ng
- Menzies Health Institute Queensland, Griffith University, Parklands Drive Southport, QLD 4222, Gold Coast, Australia
| | - Shaun O'Leary
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane St Lucia, QLD 4072, Australia; Physiotherapy Department, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, QLD 4006, Australia
| | - Philip G Conaghan
- Leeds Institute of Rheumatic & Musculoskeletal Medicine, University of Leeds & NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, LS7 4SA, UK
| | - Paul A Scuffham
- Menzies Health Institute Queensland, Griffith University, Parklands Drive Southport, QLD 4222, Gold Coast, Australia
| | - Leanne Bisset
- Menzies Health Institute Queensland, Griffith University, Parklands Drive Southport, QLD 4222, Gold Coast, Australia
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Inglis T, Schouten R, Dalzell K, Evison J, Inglis G. Access to orthopaedic spinal specialists in the Canterbury public health system: quantifying the unmet need. N Z Med J 2016; 129:19-24. [PMID: 27657155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
AIM The aim of this project was to determine the unmet need within the public health system for patients referred for elective Orthopaedic Specialist Spinal assessment and treatment in the Canterbury District Health Board (CDHB) region. METHODS Between January 2014 and January 2015 data was collected from all elective referrals to the CDHB Orthopaedic Spinal Service. During this period, the number of available outpatient appointments was set by the CDHB. Within this clinical capacity, patients were triaged by the four consultant surgeons into those of most need based on the referral letter and available radiological imaging. Those unable to be provided with a clinical appointment were discharged back to their GP for ongoing conservative care. Of those patients that received specialist assessment and were considered in need of elective surgical intervention, a proportion were denied treatment if the surgery was unable to be performed within the government determined four-month waiting time threshold. RESULTS During the study period, 707 patients were referred to the CDHB orthopaedic spinal team for elective specialist assessment. Of these, 522 (74%) were declined an outpatient appointment due to a lack of available clinical time. Of the 185 patients given a specialist assessment, 158 (85%) were recommended for elective surgery. Ninety-one (58%) were denied surgery and referred back for ongoing GP care due to unavailable operating capacity within the four-month waiting list threshold. Within this group of 91 patients, 16 patients were declined on multiple occasions (14 patients twice and two patients on three occasions). CONCLUSIONS This study quantifies the unmet need for both Spinal Orthopaedic Specialist assessment and, if warranted, surgical management of elective spine conditions within the Canterbury public health system. It highlights the degree of rationing within the public health system and its failure to adequately provide for the Canterbury Public.
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Affiliation(s)
- Tom Inglis
- Orthopaedic Trainee, Orthopaedic Department, Christchurch and Burwood Hospitals, Canterbury District Health Board, Christchurch
| | - Rowan Schouten
- Consultant Orthopaedic Surgeon, Orthopaedic Department, Christchurch and Burwood Hospitals, Canterbury District Health Board, Christchurch
| | - Kristian Dalzell
- Consultant Orthopaedic Surgeon, Orthopaedic Department, Christchurch and Burwood Hospitals, Canterbury District Health Board, Christchurch
| | - Jeremy Evison
- Consultant Orthopaedic Surgeon, Orthopaedic Department, Christchurch and Burwood Hospitals, Canterbury District Health Board, Christchurch
| | - Grahame Inglis
- Consultant Orthopaedic Surgeon, Orthopaedic Department, Christchurch and Burwood Hospitals, Canterbury District Health Board, Christchurch
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Dougherty PJ, Kromrei H. CORR (®) Curriculum - Orthopaedic Education: Quality Improvement in Resident Education. Clin Orthop Relat Res 2016; 474:1939-42. [PMID: 27351884 PMCID: PMC4965391 DOI: 10.1007/s11999-016-4952-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 06/16/2016] [Indexed: 01/31/2023]
Affiliation(s)
- Paul J Dougherty
- Detroit Medical Center, 4201 St. Antoine, Suite 4G, Detroit, MI, 48201, USA.
| | - Heidi Kromrei
- Detroit Medical Center, 4201 St. Antoine, Suite 4G, Detroit, MI, 48201, USA
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Hashem J, Culbertson MD, Munyak J, Choueka J, Patel NP. The Need for Clinical Hand Education in Emergency Medicine Residency Programs. Bull Hosp Jt Dis (2013) 2016; 74:203-206. [PMID: 27620543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Complaints related to the hands, wrists, and fingers comprise approximately 3.7 million emergency department visits annually. The complexity of this subject can confound timely diagnosis and treatment, particularly if the treating physician has not received specialized training. We set out to determine whether emergency medicine training in the USA provides adequate preparation for dealing with the identification, management, and treatment of hand, wrist, and finger injuries. METHODS The curricula for 160 accredited U.S. emergency medicine programs were obtained. Each of these was examined to see whether a clinical "hand" rotation was included as a required module. Clinical hand rotations were then classified by length of rotation, the postgraduate years in which they were offered, and if they were offered as stand-alone modules or combined with other rotations. RESULTS Of the 160 programs, 21 (13.1%) require a clinical hand rotation. Sixteen offer a dedicated module, and five are part of another rotation. The mean amount of time dedicated to hand education was 3 weeks. The 16 dedicated hand rotations had a mean duration of 2.69 weeks; combined rotations were 4 weeks. Four incorporated hand education in the first postgraduate year (PGY-1), 13 into the second (PGY-2), and 3 into the third (PGY-3). CONCLUSIONS Despite the preponderance of hand injuries seen by emergency physicians, the clinical and legal pitfalls that accompany these conditions, and the benefits to be gained from specialized training, very few programs emphasize clinical hand training in an equivalent fashion.
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Lombardi NJ, Tucker B, Freedman KB, Austin LS, Eck B, Pepe M, Tjoumakaris FP. Accuracy of Athletic Trainer and Physician Diagnoses in Sports Medicine. Orthopedics 2016; 39:e944-9. [PMID: 27398784 DOI: 10.3928/01477447-20160623-10] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 02/15/2016] [Indexed: 02/03/2023]
Abstract
It is standard practice in high school athletic programs for certified athletic trainers to evaluate and treat injured student athletes. In some cases, a trainer refers an athlete to a physician for definitive medical management. This study was conducted to determine the rate of agreement between athletic trainers and physicians regarding assessment of injuries in student athletes. All high school athletes who were injured between 2010 and 2012 at 5 regional high schools were included in a research database. All patients who were referred for physician evaluation and treatment were identified and included in this analysis. A total of 286 incidents met the inclusion criteria. A total of 263 (92%) of the athletic trainer assessments and physician diagnoses were in agreement. In the 23 cases of disagreement, fractures and sprains were the most common injuries. Kappa analysis showed the highest interrater agreement in injuries classified as dislocations and concussions and the lowest interrater agreement in meniscal/labral injuries and fractures. In the absence of a confirmed diagnosis, agreement among health care providers can be used to infer accuracy. According to this principle, as agreement between athletic trainers and physicians improves, there is a greater likelihood of arriving at the correct assessment and treatment plan. Athletic trainers are highly skilled professionals who are well trained in the evaluation of athletic injuries. The current study showed that additional training in identifying fractures may be beneficial to athletic trainers and the athletes they treat. [Orthopedics. 2016; 39(5):e944-e949.].
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Fujimori T, Okuda S, Iwasaki M, Yamasaki R, Maeno T, Yamashita T, Matsumoto T, Wada E, Oda T. Validity of the Japanese Orthopaedic Association scoring system based on patient-reported improvement after posterior lumbar interbody fusion. Spine J 2016; 16:728-36. [PMID: 26826003 DOI: 10.1016/j.spinee.2016.01.181] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [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: 06/01/2015] [Revised: 10/13/2015] [Accepted: 01/15/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The Japanese Orthopaedic Association (JOA) scoring system is a physician-based outcome that has been used to evaluate treatment effectiveness after lumbar surgery. However, patient-centered evaluation becomes increasingly important. There is no study that has examined the relationship between the JOA scoring system and patients' self-reported improvement. PURPOSE The purpose of the present study was to validate the JOA scoring system for assessment of patient-reported improvement after lumbar surgery. STUDY DESIGN This is a retrospective review of prospectively collected data. PATIENT SAMPLE The patient sample included 273 mail-in responders of the 466 consecutive patients who underwent posterior lumbar interbody fusion for spondylolisthesis between 1996 and 2008 in a single hospital. OUTCOME MEASURES The outcome measures were the JOA scoring system and patients' self-reported improvement. METHODS Two hundred seventy three patients were divided into five anchoring groups based on self-reported improvement from "Much better" to "Much worse." Outcomes (ie, recovery rate, amount of change from preoperative condition, and postoperative score) based on the JOA scoring system were compared among groups. Using the patient's self-reported improvement scale as an anchor, the association among each of the outcomes was examined. The cutoff point and the area under the curve (AUC) that differentiated "Improved" from "Neither improved nor worse" was calculated using receiver operating characteristic (ROC) curve analysis. RESULTS The recovery rate and postoperative score were significantly different in 9 of 10 pairs of anchoring groups. The amount of change was significantly different in six pairs. Spearman correlation coefficient for the 5-point scale anchors of patients' self-reported improvement was 0.20 (p=.001) for the baseline score, 0.31 (p<.001) for the amount of change, 0.55 (p<.001) for the recovery rate, and 0.56 (p<.001) for the postoperative score. According to ROC analysis, the best cutoff points and AUCs were 13 points and 0.69, respectively, for the amount of change, 67% and 0.73, respectively, for recovery rate, and 23 points and 0.72, respectively, for postoperative score. CONCLUSIONS The JOA scoring system is a valid method for assessment of patients' self-reported improvement. Patients' self-reported improvement is more likely to be associated with the final condition, such as postoperative score or recovery rate, rather than the change from the preoperative condition.
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Affiliation(s)
- Takahito Fujimori
- Department of Orthopaedic Surgery, Sumitomo Hospital, 5-3-20 Kitaku Nakanoshima, Osaka 530-0005, Japan.
| | - Shinya Okuda
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, 1179-3 Kitaku Nagasonetyou, Sakai, Osaka, Japan
| | - Motoki Iwasaki
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, 1179-3 Kitaku Nagasonetyou, Sakai, Osaka, Japan
| | - Ryoji Yamasaki
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, 1179-3 Kitaku Nagasonetyou, Sakai, Osaka, Japan
| | - Takafumi Maeno
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, 1179-3 Kitaku Nagasonetyou, Sakai, Osaka, Japan
| | - Tomoya Yamashita
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, 1179-3 Kitaku Nagasonetyou, Sakai, Osaka, Japan
| | - Tomiya Matsumoto
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, 1179-3 Kitaku Nagasonetyou, Sakai, Osaka, Japan
| | - Eiji Wada
- Department of Orthopaedic Surgery, Ehime Prefectural Central Hospital, 83 Kasugatyou, Matsuyama, Ehime, Japan
| | - Takenori Oda
- Department of Orthopaedic Surgery, Sumitomo Hospital, 5-3-20 Kitaku Nakanoshima, Osaka 530-0005, Japan
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Otto ME, Senter C, Gonzales R, Gleason N. Referring wisely: orthopedic referral guidelines at an academic institution. Am J Manag Care 2016; 22:e185-e191. [PMID: 27266584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To develop local orthopedic guidelines for use in referral decision support and electronic consultation programs at University of California, San Francisco Health. STUDY DESIGN Modified Delphi method. METHODS We performed a 2-phase modified Delphi study to identify consensus between primary care and orthopedic clinicians for common musculoskeletal problems. RESULTS Clinicians agreed that confirming patient interest in an orthopedic procedure should be completed prior to referral in 81% of clinical scenarios, as well as conservative management in 80%, physical therapy in 60%, and x-ray prior to referral in 42% of scenarios. Clinicians agreed an MRI should not be performed prior to referral in most (58%) clinical scenarios. CONCLUSIONS In the absence of national guidelines, a process for local guideline generation is needed in order to provide nuanced and detailed decision support at the point of referral. The Delphi method proved an effective process to achieve this end.
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Affiliation(s)
- Maria E Otto
- University of California, San Francisco, 1701 Divisadero St, Ste 500, San Francisco, CA 94143. E-mail:
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Waterman BR. Sports Medicine Fellowship: What Should I Be Looking For? Am J Orthop (Belle Mead NJ) 2016; 45:E124-E126. [PMID: 26991578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Brian R Waterman
- Department of Orthopaedic Surgery and Rehabilitation, William Beaumont Army Medical Center/Texas Tech University Health Sciences Center, El Paso, TX.
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Urrutia J, Orrego M, Wright AC, Amenabar D. An assessment of the Chilean National Examination of Orthopaedic Surgery. BMC Med Educ 2016; 16:78. [PMID: 26925852 PMCID: PMC4772443 DOI: 10.1186/s12909-016-0604-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 02/16/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND The Chilean National Examination of Orthopaedic Surgery (EMNOT) has been administered since 2009. It was developed to determine whether individual residents are meeting minimal knowledge standards at the end of their training programs. METHODS We performed a retrospective evaluation of the EMNOT for all years it has been administered (2009-2015). The test was analyzed for content, taxonomy of questions asked (1: direct recall; 2: diagnosis; 3: evaluation/decision-making), residents' performance, difficulty index and discrimination index. RESULTS During the years of EMNOT administration, the most frequently tested areas have been pediatric orthopaedics (22.9 %), spine (13.8 %), general orthopaedics (13.8 %) and musculoskeletal trauma (9.9 %). A significant increase in questions with images was observed, as well as a significant decrease in the percentage of Type 1 and an increase in Type 3 questions. The Difficulty Index showed a medium level of difficulty for all years the examination has been administered. The Discrimination Index showed good discrimination in 2009, fair discrimination from 2010 through 2012, and excellent discrimination from 2013 through 2015. CONCLUSION The EMNOT has evolved over several years to include better quality questions, better discrimination, and a more representative distribution of questions covering the different orthopaedic sub-specialties. This examination represents an effective instrument for quality assurance of orthopaedic residency programs in Chile.
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Affiliation(s)
- Julio Urrutia
- Department of Orthopaedic Surgery, School of Medicine, Pontificia Universidad Catolica de Chile, Marcoleta 352, Santiago, Chile.
| | - Mario Orrego
- Department of Orthopaedic Surgery, Universidad de Los Andes, Santiago, Chile
| | - Ana C Wright
- Center of Medical Education, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Diego Amenabar
- Department of Orthopaedic Surgery, Universidad de Los Andes, Santiago, Chile
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Hanypsiak BT. Make Room on Your Shelves. Am J Orthop (Belle Mead NJ) 2016; 45:107-108. [PMID: 26991560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Milone MT, Bernstein J. On Track to Professorship? A Bibliometric Analysis of Early Scholarly Output. Am J Orthop (Belle Mead NJ) 2016; 45:E119-E123. [PMID: 26991577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Academic productivity, demonstrated by a record of scholarly publication, is the main criterion for academic promotion. Nevertheless, there are no data on early-career productivity milestones to guide young faculty members aspiring to attain professor status. We performed a bibliometric analysis to determine the number of scholarly papers published by current professors of orthopedic surgery within 5 years after their having acquired American Board of Orthopaedic Surgery certification (termed early scholarly output). Median early scholarly output for all professors (N = 108) was 11 publications. We found medians of 5 first-author and 2 last-author publications, and 4 publications in Clinical Orthopaedics and Related Research or Journal of Bone and Joint Surgery. Median number of papers cited at least 50 times by year 5 was 2. The median number of total citations was 29.5, and median Hirsch index (h-index) was 3. Faculty who were clinical professors published fewer papers and acquired fewer citations than faculty who were promoted but did have the clinical descriptor. Professors certified after 1995 were more productive than those certified before 1990. This descriptive study provided benchmark data on early scholarly productivity of current professors of orthopedic surgery and demonstrated this benchmark has risen in more recent years.
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Quinn RH, Sanders JO, Brown GA, Murray J, Pezold R. The American Academy of Orthopaedic Surgeons Appropriate Use Criteria on the Management of Anterior Cruciate Ligament Injuries. J Bone Joint Surg Am 2016; 98:153-5. [PMID: 26791036 DOI: 10.2106/jbjs.o.00939] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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69
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Mohtadi NG. Outcome Measure Development. Instr Course Lect 2016; 65:577-582. [PMID: 27049222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Measuring patient-reported outcomes is the current method for conducting clinical research. Creating a new outcome measure is an exhaustive process that should be carefully monitored and concentrated on only important and common conditions. The evaluation of an existing outcome measure should involve assessing its internal consistency, reliability, floor and ceiling effects, validity, and ability to measure clinically meaningful change. The most important characteristic of a patient-reported outcome is that it is developed with direct input from its target patient population. Item generation and reduction is the most critical step in the development process because it "guarantees" that patients have communicated what is important to them and represents content validity. Outcome measures should not change; rather, they should demonstrate responsiveness by being reproducible and reliable if a patient's clinical condition is stable or reflect differences if a patient's clinical condition varies. Validation is an iterative process and requires patients from different settings and circumstances.
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Affiliation(s)
- Nicholas G Mohtadi
- Clinical Professor, Sports Medicine Centre, University of Calgary, Calgary, Alberta, Canada
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70
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Tsapaki V, Tsalafoutas IA, Fagkrezos D, Lazaretos I, Nikolaou VS, Efstathopoulos N. Patient radiation doses in various fluoroscopically guided orthopaedic procedures. Radiat Prot Dosimetry 2016; 168:72-75. [PMID: 25688062 DOI: 10.1093/rpd/ncv007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 01/17/2015] [Indexed: 06/04/2023]
Abstract
All orthopaedic fluoroscopic procedures performed using C-arm guidance were monitored for 1 y. The type of procedure, fluoroscopy time (T), kerma-area product (KAP) values and number of radiographs (F) were recorded. The two most often performed techniques were as follows: intramedullary nailing (IMN) of intertrochanteric/peritrochanteric (IP) fractures (101 cases, 49.3 %) and antergrade IMN of femur or tibia shaft (TS) fractures (28 cases, 13.7 %). For the remaining procedures, none accounted for >5 %, categorised as 'various' (76 cases, 37 %). Large variations in T, KAP and F were observed. For IMN of IP fractures, antergrade IMN of femur and TS fractures and for various procedures, respectively, median values were T--2.1, 2.2 and 0.6 min, KAP--6.3, 6.3 and 0.6 Gy cm(-2) and F--21, 2.2 and 6.7. The patient doses during fluoroscopically guided procedures are relatively low compared with other interventional procedures.
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Affiliation(s)
- V Tsapaki
- Radiology Department and Medical Physics Unit, Konstantopouleio General Hospital, Agias Olgas 3-5, Nea Ionia 14233, Greece
| | - I A Tsalafoutas
- Medical Physics Department, Agios Savvas Hospital, 171 Alexandras Av, Athens 11522, Greece
| | - D Fagkrezos
- Radiology Department and Medical Physics Unit, Konstantopouleio General Hospital, Agias Olgas 3-5, Nea Ionia 14233, Greece
| | - I Lazaretos
- 2nd Department of Trauma and Orthopedics, National and Kapodistrian University of Athens, Athens, Greece
| | - V S Nikolaou
- 2nd Department of Trauma and Orthopedics, National and Kapodistrian University of Athens, Athens, Greece
| | - N Efstathopoulos
- 2nd Department of Trauma and Orthopedics, National and Kapodistrian University of Athens, Athens, Greece
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71
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Hawkins RJ. Recommendations for Evaluating and Selecting Appropriately Valued Outcome Measures. Instr Course Lect 2016; 65:587-591. [PMID: 27049224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The changing healthcare environment has essentially mandated that outcome scores play an increasing role in orthopaedic research and clinical care. Value is defined as the best outcome at the lowest cost. The reasoning behind the collection of outcome scores can be examined from several perspectives. The process of selecting an appropriate outcome measure involves analyzing its psychometrics in addition to other aspects, such as responsiveness, reliability, validity, and the ability to detect change in a reasonable manner. A minimal clinically important difference measures clinical change, and a minimal detectable change measures statistical change. Orthopaedic surgeons are most interested in minimal clinically important differences because they indicate meaningful clinical changes. Guidelines for selecting appropriately valued outcome measures include the consideration of patient-reported outcomes, proper psychometrics, validated scores, and cost effectiveness.
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Affiliation(s)
- Richard J Hawkins
- Orthopaedic Surgeon, Steadman Hawkins Clinic of the Carolinas, Greenville Health System, Greenville, South Carolina
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Dua K, McAvoy WC, Klaus SA, Rappaport DI, Rosenberg RE, Abzug JM. Hospitalist Co-management of Pediatric Orthopaedic Surgical Patients at a Community Hospital. Md Med 2016; 17:34-36. [PMID: 27443131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
PURPOSE The benefits of hospitalist co-management of pediatric surgical patients include bettering patient safety, decreasing negative patient outcomes, providing comprehensive medical care, and establishing a dedicated resource to patients for postoperative care. The purpose of this study was to characterize the nature of patients co-managed by a pediatric hospitalist. The authors hypothesize that hospitalist co-management is safe and efficacious in pediatric orthopaedic surgical patients who are admitted to a community hospital. METHODS A retrospective review was performed of all pediatric orthopaedic surgical patients admitted to a community hospital who were co-managed by a pediatric hospitalist. Indications for hospitalization included pain control, antibiotic infusion, and need for neurovascular monitoring. Parameters of postoperative care and co-management were assessed, including presence of complications, medication introduction or adjustment by the hospitalist, follow-up adherence, and readmission/complication rates after discharge. RESULTS Thirty-two patients were assessed with an average age of 8.8 years. Twenty-five percent of patients had an associated comorbidity, including asthma, attention deficit disorder, and/or autism. The pediatric hospitalist added pain medication to the original postoperative orders placed by the orthopaedics team in 44 percent of patients (14 of the 32) either for breakthrough pain or better long-term coverage. Additionally, 25 percent of patients had pain medication adjusted from the original dosing and schedule. The hospitalist team contacted the surgeon about the four patients (12.5 percent). In three of the cases, the surgeon was contacted to discuss pain medication, and one patient woke up agitated from anesthesia, necessitating a visit from the surgeon on the pediatrics floor. The length of stay was one day for all patients. The hospitalists rounded on and discharged patients the subsequent morning. All patients were given a follow-up appointment and schedule by the hospitalist team, and every patient followed up accordingly within ten days of discharge. No complications or hospital readmissions occurred within thirty days of discharge. CONCLUSION Hospitalist co-management of pediatric orthopaedic surgical patients in a community hospital allows for better medical comorbidity and medication management. Hospitalists can provide closer observation during the inpatient stay and help streamline communication between providers and patients while allowing the surgeon the ability to be more mobile. Co-management is safe and efficacious in pediatric orthopaedic surgical patients who are admitted to a community hospital.
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Kuhn JE. Why Measure Outcomes? Instr Course Lect 2016; 65:583-586. [PMID: 27049223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The concept of measuring the outcomes of treatment in health care was promoted by Ernest Amory Codman in the early 1900s, but, until recently, his ideas were generally ignored. The forces that have advanced outcome measurement to the forefront of health care include the shift in payers for health care from the patient to large insurance companies or government agencies, the movement toward assessing the care of populations not individuals, and the effort to find value (or cost-effective treatments) amid rising healthcare costs. No ideal method exists to measure outcomes, and the information gathered depends on the reason the outcome information is required. Outcome measures used in research are best able to answer research questions. The methods for assessing physician and hospital performance include process measures, patient-experience measures, structure measures, and measures used to assess the outcomes of treatment. The methods used to assess performance should be validated, be reliable, and reflect a patient's perception of the treatment results. The healthcare industry must measure outcomes to identify which treatments are most effective and provide the most benefit to patients.
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Affiliation(s)
- John E Kuhn
- Kenneth D. Schermerhorn Professor of Orthopaedics and Rehabilitation, Department of Orthopaedic Surgery, Vanderbilt University Medical School, Nashville, Tennessee
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Gofton WT, Solomon M, Gofton T, Pagé A, Kim PR, Netting C, Bhandari M, Beaulé PE. What Do Reported Learning Curves Mean for Orthopaedic Surgeons? Instr Course Lect 2016; 65:633-643. [PMID: 27049229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Practicing orthopaedic surgeons must assess the effects of the learning curve on patient safety and surgical outcomes if a new implant, technique, or approach is being considered; however, it remains unclear how learning curves reported in the literature should be interpreted and to what extent their results can be generalized. Learning curve reports from other surgical specialties and from orthopaedic surgery can be analyzed to identify the strengths and weaknesses of learning curve reporting. Single-surgeon series and registry data can be analyzed to understand learning challenges and to develop a personalized learning plan. Learning curve reports from single-surgeon series have several limitations that result from the limited dataset reported and inconsistencies in the way data are reported. Conversely, learning curve reports from registry data are likely to have greater generalizability, but are largely beneficial retrospectively, after data from a sufficient number of surgeons are assessed. There is a pressing need for surgeons to develop improved and consistent standards for learning curve reporting. Although registry data may provide better prospective measures in the future, the implementation of such registries faces several challenges. Despite substantial limitations, single-surgeon series remain the most effective way for practicing surgeons to assess their learning challenge and develop an appropriate learning plan.
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Affiliation(s)
- Wade T Gofton
- Physician, Associate Professor, Department of Surgery, Division of Orthopedic Surgery, University of Ottawa, Ottawa, Ontario, Canada
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Kristensen PK, Thillemann TM, Søballe K, Johnsen SP. Can improved quality of care explain the success of orthogeriatric units? A population-based cohort study. Age Ageing 2016; 45:66-71. [PMID: 26582757 DOI: 10.1093/ageing/afv155] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [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: 12/03/2014] [Accepted: 08/07/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND admission to orthogeriatric units improves clinical outcomes for patients with hip fracture; however, little is known about the underlying mechanisms. OBJECTIVE to compare quality of in-hospital care, 30-day mortality, time to surgery (TTS) and length of hospital stay (LOS) among patients with hip fracture admitted to orthogeriatric and ordinary orthopaedic units, respectively. DESIGN population-based cohort study. MEASURES using prospectively collected data from the Danish Multidisciplinary Hip Fracture Registry, we identified 11,461 patients aged ≥65 years admitted with a hip fracture between 1 March 2010 and 30 November 2011. The patients were divided into two groups: (i) those treated at an orthogeriatric unit, where the geriatrician is an integrated part of the multidisciplinary team, and (ii) those treated at an ordinary orthopaedic unit, where geriatric or medical consultant service are available on request. Outcome measures were the quality of care as reflected by six process performance measures, 30-day mortality, the TTS and the LOS. Data were analysed using log-binomial, linear and logistic regression controlling for potential confounders. RESULTS admittance to orthogeriatric units was associated with a higher chance for fulfilling five out of six process performance measures. Patients who were admitted to an orthogeriatric unit experienced a lower 30-day mortality (adjusted odds ratio (aOR) 0.69; 95% CI 0.54-0.88), whereas the LOS (adjusted relative time (aRT) of 1.18; 95% CI 0.92-1.52) and the TTS (aRT 1.06; 95% CI 0.89-1.26) were similar. CONCLUSIONS admittance to an orthogeriatric unit was associated with improved quality of care and lower 30-day mortality among patients with hip fracture.
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Affiliation(s)
- Pia Kjær Kristensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark Department of Orthopedic Surgery, Hospital Horsens, Horsens, Denmark
| | | | - Kjeld Søballe
- Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Søren Paaske Johnsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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Gofton WT, Papp SR, Gofton T, Beaulé PE. Understanding and Taking Control of Surgical Learning Curves. Instr Course Lect 2016; 65:623-631. [PMID: 27049228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
As surgical techniques continue to evolve, surgeons will have to integrate new skills into their practice. A learning curve is associated with the integration of any new procedure; therefore, it is important for surgeons who are incorporating a new technique into their practice to understand what the reported learning curve might mean for them and their patients. A learning curve should not be perceived as negative because it can indicate progress; however, surgeons need to understand how to optimize the learning curve to ensure progress with minimal patient risk. It is essential for surgeons who are implementing new procedures or skills to define potential learning curves, examine how a reported learning curve may relate to an individual surgeon's in-practice learning and performance, and suggest methods in which an individual surgeon can modify his or her specific learning curve in order to optimize surgical outcomes and patient safety. A defined personal learning contract may be a practical method for surgeons to proactively manage their individual learning curve and provide evidence of their efforts to safely improve surgical practice.
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Affiliation(s)
- Wade T Gofton
- Physician, Associate Professor, Department of Surgery, Division of Orthopedic Surgery, University of Ottawa, Ottawa, Ontario, Canada
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Jans LCH, Kranzbühler AM. The influence of rating volume in the effects of expert versus patient online ratings. Acta Orthop Belg 2015; 81:662-667. [PMID: 26790788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Gaining access to ratings has become much easier due to the internet and research shows that they are of influence on consumer decision making. At healthcare comparison websites, patients are gradually sharing their opinions online whereby the number of ratings can differ significantly per provider. Because patients may lack the necessary skills and information to judge health care quality, some platforms complement patient ratings with an expert rating. It is unclear however which source has the biggest influence on decision making. A previous study found that generally people seem to follow their peers, but only when they are in large numbers. Otherwise, they follow the expert. The present study aims to find out how many peers are necessary to "overrule" the expert. An online experiment is conducted and the results indicate that rating volume does play a role in the effects of patient versus expert ratings. This finding can, for example, support platform providers in understanding how to use online ratings to ensure that patients benefit most of them.
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McCann PD. Value and the Orthopedic Surgeon. Am J Orthop (Belle Mead NJ) 2015; 44:537. [PMID: 26665238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Peter D McCann
- Department of Orthopaedic Surgery, Beth Israel Medical Center; Albert Einstein College of Medicine of Yeshiva University, New York, NY
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McDonald-Lynch MB, Marcellin-Little DJ, Roe SC, Lascelles BDX, Trumpatori BJ, Griffith EH. Assessment of an implant-skin interface scoring system for external skeletal fixation of dogs. Am J Vet Res 2015; 76:931-8. [PMID: 26512537 DOI: 10.2460/ajvr.76.11.931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess intraobserver repeatability and interobserver and in vivo versus photographic agreement of a scoring system for the implant-skin interface (ISI) of external skeletal fixation (ESF). SAMPLE 42 photographs of ISIs from 18 dogs for interobserver agreement and intraobserver repeatability and 27 photographs of ISIs from 6 dogs for in vivo versus photograph agreement. PROCEDURES An ISI inflammation scoring system was developed. It included scales for 6 metrics (erythema, drainage amount, drainage type, swelling, hair loss or lack of hair regrowth, and granulation tissue). Photographs of the ISI of ESF were obtained by use of a standard protocol and evaluated to determine intraobserver repeatability and interobserver agreement (Cronbach α; 4 raters) of the ISI score. Agreement between in vivo and photographic ISI scores (2 raters) and correlation between median scores across metrics were evaluated. RESULTS 42 photographs met the inclusion criteria. Overall intraclass correlation coefficients ranged from 0.922 to 0.975. Interobserver overall Cronbach α ranged from 0.835 to 0.943. For in vivo versus photographic assessment, 27 ISIs in 6 dogs and their photographs were evaluated. The Cronbach α for both raters ranged from 0.614 to 0.938. Overall, the Cronbach α ranged from 0.725 to 0.932. Mean photographic scores were greater than mean in vivo scores for each metric. Pearson correlation coefficients ranged from 0.221 to 0.923. Erythema, swelling, and granulation were correlated with all other metrics. CONCLUSIONS AND CLINICAL RELEVANCE In this study, an ISI scoring system used in this study had high repeatability and agreement and may therefore be considered for use in clinical situations. Photographic scores were not equivalent to in vivo scores and should not be used interchangeably.
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Knutsson B, Torstensson T. [New routines in orthopedics department yielded more efficient care and more satisfied patients. Physiotherapist and team make the first assessment in new visits to the spine surgeon]. Lakartidningen 2015; 112:DI7C. [PMID: 26371481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
There is a shortage of spine surgeons in Sweden. To guarantee the legal right to healthcare, many counties must hire doctors, with increasing costs. In our new out-patient department routine, the majority of the patients are examined by a physiotherapist at their first visit. History taking and clinical and radiographic examinations are discussed in a team conference, and possible candidates for spine surgery are selected for an appointment with a spine surgeon. Furthermore, the patients were more satisfied with the new routine and management plan.
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Affiliation(s)
- Björn Knutsson
- - Orthopedics Sundsvall, Sweden - Orthopedics Sundsvall, Sweden
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81
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Wirtz DC, Stöckle U. [Quality Assurance and Quality Assessment]. Z Orthop Unfall 2015; 153:374. [PMID: 26344375 DOI: 10.1055/s-0035-1557839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Abstract
Hip arthroscopy is an increasingly common procedure, particularly for the treatment of femoroacetabular impingement. Various complications have been previously reported, and the authors sought to further evaluate the safety of this procedure. This study was conducted to identify the incidence of femoral neck fracture as well as treatment and outcomes after arthroscopic femoroplasty. In April 2013, a survey was administered to 28 established hip arthroscopists regarding the breadth of their experience, including the total number of hip arthroscopies and proximal femoroplasties performed and the number of postoperative femoral neck fractures. Fracture type, patient age, patient sex, time to fracture, comorbidities, treatments, and outcomes were queried. The study identified 27,200 total arthroscopies and 14,945 proximal femoroplasties performed by the surgeons, with 11 postoperative proximal femur fractures. The incidence of proximal femur fracture after arthroscopic femoroplasty was 0.07%, based on combined data of high-volume hip arthroscopists at multiple medical centers. Mean time to fracture after arthroscopic femoroplasty was 40.5 (±26.6) days postoperatively. The male-to-female ratio was approximately 1:3 for those with fracture, and mean patient age was 52 (±13) years. More than half of the fractures were caused by violation of weight-bearing precautions. All patients had improvement in symptoms after treatment. Femoral neck fracture after arthroscopic femoroplasty is a rare complication for established hip arthroscopists. It is most common in women and patients older than 50 years. Treatment is based on the severity of the fracture, and patients have improved outcomes after treatment.
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Prodromidis AD, Kamath V, Charalambous CP. Evaluating a Ward-based Foundation Year 1 (FY1) System in an Orthopaedic Setting. Ortop Traumatol Rehabil 2015; 17:393-397. [PMID: 26468176 DOI: 10.5604/15093492.1173381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Various models of hospital in-patient cover arrangements for junior doctors have been utilised in the United Kingdom. Some settings follow a team-based system for junior doctors and some a ward-based system. The aim of this study was to determine staff's satisfaction rates with regard to a ward-based system for Foundation Year 1 (FY1) doctors in relation to continuity of patient care and doctors' training. MATERIAL AND METHODS The Orthopaedic department of a District Teaching Hospital in the United Kingdom moved to a ward-based system for the FY1s from a previous team-based system. A questionnaire was administered to FY1s, nursing staff and senior doctors asking their satisfaction rates. RESULTS 42 practitioners were questioned. They included 15 FY1s, 15 ward nurses and 12 senior doctors. 73.3% of FY1s were satisfied with the ward-based system with regard to continuity of patient care and 40% of them were very satisfied/satisfied with it with regard to achieving training objectives. All nurses, 66.7% of FY1s and 66.7% of senior doctors were very satisfied/satisfied with the ward-based system for achieving service provision (p=0.053). All nurses and 60% of FY1s preferred the ward-based system (p=0.017). All nurses and 66.7% of senior doctors rated the ward-based system as being much better/better than team-based at achieving service provision (p-0.028). CONCLUSIONS 1. Our results suggest that a ward-based system for FY1s can be successfully implemented in an orthopaedic setting. 2. Ward-based system confers high satisfaction rates with regard to care provision and continuity of care. 3. Taking into account training needs and substitutes for structured team work would be an area for improvement.
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Affiliation(s)
| | - Vijay Kamath
- Orthopaedic Department, Blackpool Victoria Hospital, Blackpool,UK
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84
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Tchetchik A, Grinstein A, Manes E, Shapira D, Durst R. From Research to Practice: Which Research Strategy Contributes More to Clinical Excellence? Comparing High-Volume versus High-Quality Biomedical Research. PLoS One 2015; 10:e0129259. [PMID: 26107296 PMCID: PMC4480880 DOI: 10.1371/journal.pone.0129259] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 05/06/2015] [Indexed: 11/18/2022] Open
Abstract
The question when and to what extent academic research can benefit society is of great interest to policy-makers and the academic community. Physicians in university hospitals represent a highly relevant test-group for studying the link between research and practice because they engage in biomedical academic research while also providing medical care of measurable quality. Physicians' research contribution to medical practice can be driven by either high-volume or high-quality research productivity, as often pursuing one productivity strategy excludes the other. To empirically examine the differential contribution to medical practice of the two strategies, we collected secondary data on departments across three specializations (Cardiology, Oncology and Orthopedics) in 50 U.S.-based university hospitals served by 4,330 physicians. Data on volume and quality of biomedical research at each department was correlated with publicly available ratings of departments' quality of care, demonstrating that high-quality research has significantly greater contribution to quality of care than high-volume research.
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Affiliation(s)
- Anat Tchetchik
- Department of Business and Management, Guilford Glazer Faculty of Management, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Amir Grinstein
- Department of Business and Management, Guilford Glazer Faculty of Management, Ben Gurion University of the Negev, Beer Sheva, Israel
- Faculty of Economics and Business Administration, VU University Amsterdam, Amsterdam, The Netherlands
- D’Amore-McKim School of Business, Northeastern University, Boston, Massachusetts, United States of America
| | - Eran Manes
- Department of Business and Management, Guilford Glazer Faculty of Management, Ben Gurion University of the Negev, Beer Sheva, Israel
- The School of Industrial Management, Jerusalem College of Technology, Jerusalem, Israel
| | - Daniel Shapira
- Department of Business and Management, Guilford Glazer Faculty of Management, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Ronen Durst
- Cardiology Division, Hadassah Hebrew University Medical Center, Jerusalem, Israel
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85
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Epping B. [EU Specialist -- a long way up to new standards for training in the EU]. Z Orthop Unfall 2015; 153:231-234. [PMID: 26193481 DOI: 10.1055/s-0035-1556918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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86
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Young SW, Clarke HD, Graves SE, Liu YL, de Steiger RN. Higher Rate of Revision in PFC Sigma Primary Total Knee Arthroplasty With Mismatch of Femoro-Tibial Component Sizes. J Arthroplasty 2015; 30:813-7. [PMID: 25534956 DOI: 10.1016/j.arth.2014.11.035] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [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: 06/20/2014] [Revised: 11/09/2014] [Accepted: 11/26/2014] [Indexed: 02/01/2023] Open
Abstract
Total knee arthroplasty (TKA) systems permit a degree of femoro-tibial component size mismatch. The effect of mismatched components on revision rates has not been evaluated in a large study. We reviewed 21,906 fixed-bearing PFC Sigma primary TKAs using the Australian Orthopaedic Association National Joint Replacement Registry, dividing patients into three groups: no femoro-tibial size mismatch, tibial component size > femoral component size, and femoral component > tibial component. Revision rates were higher when the femoral size was greater than the tibia, compared to both equal size (HR = 1.20 (1.00, 1.45), P = 0.047) and to tibial size greater than femoral (HR = 1.60 (1.08, 2.37), P = 0.019). Potential mechanisms to explain these findings include edge loading of polyethylene and increased tibial component stresses.
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Affiliation(s)
| | | | - Stephen E Graves
- Australian Orthopaedic Association National Joint Replacement Registry, Discipline of Public Health, School of Population Health, University of Adelaide, Adelaide, SA, Australia
| | - Yen-Liang Liu
- Data Management and Analysis Centre, University of Adelaide, Adelaide, SA, Australia
| | - Richard N de Steiger
- Australian Orthopaedic Association National Joint Replacement Registry, Discipline of Public Health, School of Population Health, University of Adelaide, Adelaide, SA, Australia
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87
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Affiliation(s)
- Amal Mattu
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
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88
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Sarmiento A. Orthopedic registries: second thoughts. Am J Orthop (Belle Mead NJ) 2015; 44:159-160. [PMID: 25844583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Augusto Sarmiento
- University of Miami, Coral Gables, FL; University of Southern California, Los Angeles, CA
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89
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Mont MA, Elmallah RK, Cherian JJ. The value of national and hospital registries. Am J Orthop (Belle Mead NJ) 2015; 44:160-162. [PMID: 25844584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Michael A Mont
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, MD
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90
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Paxton ES, Matzon JL, Narzikul AC, Beredjiklian PK, Abboud JA. Agreement among ASES members on the AAOS Clinical Practice Guidelines. Orthopedics 2015; 38:e169-77. [PMID: 25760503 DOI: 10.3928/01477447-20150305-53] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 05/13/2014] [Indexed: 02/03/2023]
Abstract
The American Academy of Orthopaedic Surgeons (AAOS) has recently developed several clinical practice guidelines (CPG) involving upper extremity conditions. The purpose of the current study was to evaluate the practice patterns of members of the American Shoulder and Elbow Society (ASES) with regard to the CPGs. An e-mail survey was sent to the 340 members of the ASES. The survey contained 40 questions involving the subject matter of the 2 existing AAOS CPGs pertaining specifically to the shoulder: Optimizing the Management of Rotator Cuff Problems and the Treatment of Glenohumeral Joint Arthritis. Overall, 98 responses were obtained, for a response rate of 29%. Only 19 of 47 CPGs were not "inconclusive" and a recommendation was actually made. A majority (more than 50%) of surgeons agreed with 17 (90%) of 19 of these AAOS recommendations. A strong majority (more than 80%) adhered to 13 (68%) of 19 recommendations. There were 4 consensus recommendations, and more than 50% agreed with all of them. Of the 5 moderate recommendations, more than 50% agreed with 4 of them. There were 10 weak recommendations, and more than 50% of surgeons agreed with 9 of them. There was more than 80% agreement on 18 of 28 inconclusive recommendations. Although the AAOS CPGs are not meant to be fixed protocols, they are intended to unify treatment and/or diagnosis of common problems based on the best evidence available. Despite the majority of the AAOS CPG recommendations for rotator cuff problems and glenohumeral arthritis being inconclusive, most surgeons agree with most of the CPG recommendations.
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91
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Affiliation(s)
- L Stefan Lohmander
- Orthopaedics, Department of Clinical Sciences, Lund University, 22185 Lund, Sweden
| | - Ewa M Roos
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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92
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Lewis G. Not all approved antibiotic-loaded PMMA bone cement brands are the same: ranking using the utility materials selection concept. J Mater Sci Mater Med 2015; 26:5388. [PMID: 25595722 DOI: 10.1007/s10856-015-5388-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 09/16/2014] [Indexed: 06/04/2023]
Abstract
In the literature on in vitro characterization of approved antibiotic-loaded poly(methyl methacrylate) bone cement brands, there is no information on the basis for selection of a given brand for use in cemented arthroplasties. This shortcoming is addressed in the present study. It involved determining four key properties (fatigue limit, fracture toughness, polymerization rate, and phosphate buffered saline diffusion coefficient) for six brands and then using the mean property values, in conjunction with a materials selection methodology, called the utility concept, to rank the brands. It is emphasized that the present work is an illustration of a rational approach to selection of a cement brand and, as such, the study findings are not intended to be recommendations regarding clinical use or otherwise of a brand.
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Affiliation(s)
- Gladius Lewis
- Department of Mechanical Engineering, The University of Memphis, Memphis, TN, 38152, USA,
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93
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Pfeffer GB. Raising the bar for online physician review sites. Am J Orthop (Belle Mead NJ) 2015; 44:11-12. [PMID: 25566550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Glenn B Pfeffer
- Foot and Ankle Center, Cedars-Sinai Medical Center, Los Angeles, CA
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94
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Sarmiento A. A Guideline to Fit Them All. Acta Chir Orthop Traumatol Cech 2015; 82:325-326. [PMID: 26828077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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95
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Dyer C. Locum doctor is struck off for misconduct and continued denial of wrongdoing. BMJ 2014; 349:g6816. [PMID: 25398226 DOI: 10.1136/bmj.g6816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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96
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Hirsch BP, Webb ML, Bohl DD, Fu M, Buerba RA, Gruskay JA, Grauer JN. Improving visual estimates of cervical spine range of motion. Am J Orthop (Belle Mead NJ) 2014; 43:E261-E265. [PMID: 25379754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Cervical spine range of motion (ROM) is a common measure of cervical conditions, surgical outcomes, and functional impairment. Although ROM is routinely assessed by visual estimation in clinical practice, visual estimates have been shown to be unreliable and inaccurate. Reliable goniometers can be used for assessments, but the associated costs and logistics generally limit their clinical acceptance. To investigate whether training can improve visual estimates of cervical spine ROM, we asked attending surgeons, residents, and medical students at our institution to visually estimate the cervical spine ROM of healthy subjects before and after a training session. This training session included review of normal cervical spine ROM in 3 planes and demonstration of partial and full motion in 3 planes by multiple subjects. Estimates before, immediately after, and 1 month after this training session were compared to assess reliability and accuracy. Immediately after training, errors decreased by 11.9° (flexion-extension), 3.8° (lateral bending), and 2.9° (axial rotation). These improvements were statistically significant. One month after training, visual estimates remained improved, by 9.5°, 1.6°, and 3.1°, respectively, but were statistically significant only in flexion-extension. Although the accuracy of visual estimates can be improved, clinicians should be aware of the limitations of visual estimates of cervical spine ROM. Our study results support scrutiny of visual assessment of ROM as a criterion for diagnosing permanent impairment or disability.
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Affiliation(s)
| | | | | | | | | | | | - Jonathan N Grauer
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT.
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97
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Khatri C, Sugand K, Anjum S, Vivekanantham S, Akhtar K, Gupte C. Does video gaming affect orthopaedic skills acquisition? A prospective cohort-study. PLoS One 2014; 9:e110212. [PMID: 25333959 PMCID: PMC4198251 DOI: 10.1371/journal.pone.0110212] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 09/16/2014] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Previous studies have suggested that there is a positive correlation between the extent of video gaming and efficiency of surgical skill acquisition on laparoscopic and endovascular surgical simulators amongst trainees. However, the link between video gaming and orthopaedic trauma simulation remains unexamined, in particular dynamic hip screw (DHS) stimulation. OBJECTIVE To assess effect of prior video gaming experience on virtual-reality (VR) haptic-enabled DHS simulator performance. METHODS 38 medical students, naïve to VR surgical simulation, were recruited and stratified relative to their video gaming exposure. Group 1 (n = 19, video-gamers) were defined as those who play more than one hour per day in the last calendar year. Group 2 (n = 19, non-gamers) were defined as those who play video games less than one hour per calendar year. Both cohorts performed five attempts on completing a VR DHS procedure and repeated the task after a week. Metrics assessed included time taken for task, simulated flouroscopy time and screw position. Median and Bonett-Price 95% confidence intervals were calculated for seven real-time objective performance metrics. Data was confirmed as non-parametric by the Kolmogorov-Smirnov test. Analysis was performed using the Mann-Whitney U test for independent data whilst the Wilcoxon signed ranked test was used for paired data. A result was deemed significant when a two-tailed p-value was less than 0.05. RESULTS All 38 subjects completed the study. The groups were not significantly different at baseline. After ten attempts, there was no difference between Group 1 and Group 2 in any of the metrics tested. These included time taken for task, simulated fluoroscopy time, number of retries, tip-apex distance, percentage cut-out and global score. CONCLUSION Contrary to previous literature findings, there was no correlation between video gaming experience and gaining competency on a VR DHS simulator.
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Affiliation(s)
- Chetan Khatri
- MSk Lab, Imperial College London, Charing Cross Hospital, London, United Kingdom
| | - Kapil Sugand
- MSk Lab, Imperial College London, Charing Cross Hospital, London, United Kingdom
| | - Sharika Anjum
- MSk Lab, Imperial College London, Charing Cross Hospital, London, United Kingdom
| | | | - Kash Akhtar
- MSk Lab, Imperial College London, Charing Cross Hospital, London, United Kingdom
| | - Chinmay Gupte
- MSk Lab, Imperial College London, Charing Cross Hospital, London, United Kingdom
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99
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Hangody L, Radnai A. [Orthopedic care with a wide scope at the Dr. Rose Private Hospital. Conversation with Prof. Dr. László Hangody]. Orv Hetil 2014; 155:1329-30. [PMID: 25109920 DOI: 10.1556/oh.2014.33m] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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100
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Brooks F, Clark A, O'Neil R, James C, Power C, Gillett M, Tindall S, Abdulrahman G, Murray C, Ahuja S. A multi-centred audit of secondary spinal assessments in a trauma setting: are we ATLS compliant? Eur J Orthop Surg Traumatol 2014; 24 Suppl 1:S215-S219. [PMID: 24306164 DOI: 10.1007/s00590-013-1371-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 11/16/2013] [Indexed: 06/02/2023]
Abstract
PURPOSE The global incidence of spinal cord injuries varies with the developed world having improved survival and 1 year mortality in a poly-trauma setting. This improved survival has been estimated at 20 % in a recent Cochrane review of Advanced Trauma Life Support (ATLS).The aim of this audit is to evaluate the management of patients with suspected spinal cord injury by the trauma and orthopaedic team in three centres in South Wales. METHODS A retrospective case note review of the secondary survey was performed. Inclusion criteria were patients 18 years and above, with poly-trauma and presenting to Accident and Emergency department at the treating hospital. We used ATLS guidelines as an audit tool and reviewed the documentation of key components of the secondary assessment. RESULTS Forty-nine patients were included (29 males, 20 females) with an average age of 53.7 years (19-92 years). We found that completion of all components of the secondary survey for spinal injury was poor, 29 % receiving a digital per rectal examination despite suspected spinal injury. Paralysis level was not documented in 20.4 % of patients. Medical Research Council grade was only documented in 24.5 % although was assessed in 73.5 %. The secondary survey took place after 2 h in 54.6 % of patients. CONCLUSION We found that the documentation of the performance of a secondary survey was poor. We found that most patients included in this study are not currently meeting the minimal standard suggested by the ATLS guidelines.
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Affiliation(s)
- Francis Brooks
- Welsh Institute of Spinal Injuries, University Hospital of Wales, Cardiff, UK,
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