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Vidal EIDO, Ribeiro LFA, Carvalho-Filho MAD, Fukushima FB. Mindfulness training in medical education as a means to improve resilience, empathy, and mental health in the medical profession. World J Psychiatry 2024; 14:489-493. [PMID: 38659597 PMCID: PMC11036457 DOI: 10.5498/wjp.v14.i4.489] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/17/2024] [Accepted: 03/13/2024] [Indexed: 04/17/2024] Open
Abstract
The high rates of depression, burnout, and increased risk of suicide among medical students, residents, and physicians in comparison with other careers signal a mental health crisis within our profession. We contend that this crisis coupled with the inadequate acquisition of interpersonal skills during medical education results from the interaction between a challenging environment and the mental capital of individuals. Additionally, we posit that mindfulness-based practices are instrumental for the development of major components of mental capital, such as resilience, flexibility of mind, and learning skills, while also serving as a pathway to enhance empathy, compassion, self-awareness, conflict resolution, and relational abilities. Importantly, the evidence base supporting the effectiveness of mindfulness-based interventions has been increasing over the years, and a growing number of medical schools have already integrated mindfulness into their curricula. While we acknowledge that mindfulness is not a panacea for all educational and mental health problems in this field, we argue that there is currently an unprecedented opportunity to gather momentum, spread and study mindfulness-based programs in medical schools around the world as a way to address some longstanding shortcomings of the medical profession and the health and educational systems upon which it is rooted.
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Affiliation(s)
- Edison Iglesias de Oliveira Vidal
- Internal Medicine Department, Botucatu Medical School, Sao Paulo State University (UNESP), Botucatu 18618-687, SP, Brazil
- Wenckebach Institute for Education and Training, LEARN - Lifelong Learning, Education and Assessment Research Network, University Medical Center Groningen, Groningen 9713AV, Groningen, Netherlands
| | | | - Marco Antonio de Carvalho-Filho
- Wenckebach Institute for Education and Training, LEARN - Lifelong Learning, Education and Assessment Research Network, University Medical Center Groningen, Groningen 9713AV, Groningen, Netherlands
| | - Fernanda Bono Fukushima
- Wenckebach Institute for Education and Training, LEARN - Lifelong Learning, Education and Assessment Research Network, University Medical Center Groningen, Groningen 9713AV, Groningen, Netherlands
- Surgical Specialties and Anesthesiology Department, Botucatu Medical School, São Paulo State University (UNESP), Botucatu 18618-687, SP, Brazil
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Teixeira LA, Vidal EIDO, Blake H, Barros GAMD, Fukushima FB. Evaluating the Interaction Between Pain Intensity and Resilience on the Impact of Pain in the Lives of People With Fibromyalgia. Clin J Pain 2024; 40:150-156. [PMID: 37994738 DOI: 10.1097/ajp.0000000000001178] [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] [Received: 10/10/2023] [Accepted: 11/12/2023] [Indexed: 11/24/2023]
Abstract
OBJECTIVE Recent theoretical models posit that resilience acts as a resource/mechanism opposing pain catastrophizing and other vulnerability sources against pain adaptation. The aim of this study was to investigate the relationship between resilience, pain, and functionality in people living with fibromyalgia (FM). MATERIALS AND METHODS We conducted a cross-sectional online survey of people participating in Brazilian fibromyalgia virtual support groups on Facebook in May 2018. Resilience was evaluated by the Connor-Davidson Resilience Scale. Average pain and the degree of interference of pain in the lives of participants (DIPLP) were assessed using the Brief Pain Inventory. The association between these 3 variables was evaluated through multivariable robust linear regression with adjustment for 21 potential confounders. RESULTS We included 2176 participants with FM. Resilience was associated with a decreased DIPLP (β: -0.38, 95% CI: -0.54 to -0.22, P <0.001) but not with average pain scores (β: -0.01, 95% CI: -0.18 to 0.16, P =0.93). A significant interaction between resilience and average levels of pain on the DIPLP was observed so that resilience showed a much stronger protective association among participants with average null-to-mild pain than among those with moderate and severe pain levels. DISCUSSION Our results provide evidence against beliefs that the pain of people with FM is related to low psychological resilience and shed light on the complex interrelationships between resilience, pain, and functionality. This research signals both the relevance and limits of resilience in the management of FM. Future studies evaluating behavioral interventions for FM should consider how those interventions interact with baseline pain levels and resilience.
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Affiliation(s)
| | | | - Holly Blake
- School of Health Sciences, University of Nottingham
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK
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Moro MZ, de Oliveira Vidal EI, Pinheiro Módolo NS, Bono Fukushima F, Moreira de Barros GA. Dry needling, trigger point electroacupuncture and motor point electroacupuncture for the treatment of myofascial pain syndrome involving the trapezius: a randomised clinical trial. Acupunct Med 2024; 42:3-13. [PMID: 37905789 DOI: 10.1177/09645284231207865] [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] [Indexed: 11/02/2023]
Abstract
OBJECTIVE The objective of this study was to compare trigger point (TrP) dry needling, TrP electroacupuncture and motor point electroacupuncture of the trapezius muscle for the treatment of myofascial pain syndrome (MPS). METHODS This randomised clinical trial included 90 patients divided into three groups. Group 1 was treated with dry needling of TrPs, group 2 with intramuscular electrical stimulation of TrPs, and group 3 with electroacupuncture of motor points and/or the spinal accessory nerve. Each group received seven treatment sessions. The outcomes were the pain score measured by visual analogue scale (VAS) and quality of life evaluated by the 12-item short form (SF-12) health questionnaire. We compared the pain outcome over serial time points using growth curve analysis methods. RESULTS Participants in the three groups experienced significant improvements in pain scores over time. The average pain level of participants in group 3 across the repeated assessments was 0.98 units lower than in group 1 (mean difference (95% confidence interval (CI) = 1.74-0.23)), p = 0.012). There were no significant differences in pain scores between participants in groups 1 and 2, and there were no significant differences in quality of life across the three groups at the end of the treatment period. CONCLUSION Our results provide evidence that electrical stimulation of motor points and/or of the spinal accessory nerve may be superior in terms of pain relief (but not quality of life) to dry needling and possibly electrical stimulation of trigger points for the management of MPS involving the trapezius. TRIAL REGISTRATION NUMBER TRIAL-RBR-43R7RF (Brazilian Clinical Trials Registry).
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Affiliation(s)
- Marlene Zuccolotto Moro
- Department of Surgical Specialties and Anesthesiology, Botucatu Medical School, Sao Paulo State University (Unesp), Botucatu, Brazil
| | - Edison Iglesias de Oliveira Vidal
- Department of Surgical Specialties and Anesthesiology, Botucatu Medical School, Sao Paulo State University (Unesp), Botucatu, Brazil
| | - Norma Sueli Pinheiro Módolo
- Department of Surgical Specialties and Anesthesiology, Botucatu Medical School, Sao Paulo State University (Unesp), Botucatu, Brazil
| | - Fernanda Bono Fukushima
- Department of Surgical Specialties and Anesthesiology, Botucatu Medical School, Sao Paulo State University (Unesp), Botucatu, Brazil
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Miranda LA, Luvizutto GJ, Stephan BCM, Souza JTD, Silva TRD, Winckler FC, Ferreira NC, Antunes LCDO, Bessornia PAC, Bazan SGZ, Fukushima FB, Costa RDMD, Modolo GP, Minicucci MF, Bazan R, Vidal EIDO. Evaluating the performance of the PRISMA-7 frailty criteria for predicting disability and death after acute ischemic stroke. J Stroke Cerebrovasc Dis 2022; 31:106837. [PMID: 36283237 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 10/15/2022] [Indexed: 11/06/2022] Open
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Araujo CFM, Nunes LC, Murta-Nascimento C, Souza CDP, Bragagnoli AC, Fukushima FB, Vidal EIDO. Metformin for the treatment of breast cancer: protocol for a scoping review of randomised clinical trials. BMJ Open 2021; 11:e044283. [PMID: 34373290 PMCID: PMC8354283 DOI: 10.1136/bmjopen-2020-044283] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 07/27/2021] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Innovation through the repurposing of generic drugs encloses several advantages when compared with the process of developing new drugs from scratch. Metformin is an established and inexpensive antidiabetic drug for which anticancer properties have been hypothesised. A systematic review of observational studies found promising results for metformin related to breast cancer in women with diabetes. Although the number of randomised clinical trials of metformin for the treatment of breast cancer increased over the last decades, the overall landscape of those studies in this heterogeneous field remains unclear. Hence, we designed the present scoping review protocol to map the literature on randomised clinical trials of metformin in the treatment of breast cancer to determine the value and scope of future systematic reviews on this subject and identify research gaps. METHODS We will search MEDLINE (via PubMed), EMBASE, CENTRAL, LILACS, Web of Science and sources of grey literature. We will include any randomised clinical trial of metformin for the treatment of breast cancer in adult women, and will not impose restrictions regarding context, language or publication date. Two independent reviewers will screen and select studies, and chart the data. We will structure the presentation of our results based on the molecular types of breast cancer, their stages and treatment modalities. ETHICS AND DISSEMINATION As a literature review, this study is exempt from ethics approval. Findings will be disseminated through presentations in conferences and a peer-reviewed publication. OPEN SCIENCE FRAMEWORK REGISTRATION: osf.io/yquba.
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Affiliation(s)
| | - Lélia Cápua Nunes
- Public Health Department, São Paulo State University (UNESP), Medical School, Botucatu, São Paulo, Brazil
| | - Cristiane Murta-Nascimento
- Public Health Department, São Paulo State University (UNESP), Medical School, Botucatu, São Paulo, Brazil
| | | | | | - Fernanda Bono Fukushima
- Anaesthesiology Department, São Paulo State University (UNESP), Medical School, Botucatu, São Paulo, Brazil
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Vidal EIDO, Fukushima FB. The art and science of writing a scientific review article. CAD SAUDE PUBLICA 2021; 37:e00063121. [PMID: 33852695 DOI: 10.1590/0102-311x00063121] [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] [Subscribe] [Scholar Register] [Indexed: 09/25/2023] Open
Affiliation(s)
| | - Fernanda Bono Fukushima
- Faculdade de Medicina de Botucatu, Universidade Estadual Paulista Júlio de Mesquita Filho, Botucatu, Brasil
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Lovadini GB, Fukushima FB, Schoueri JFL, dos Reis R, Fonseca CGF, Rodriguez JJC, Coelho CS, Neves AF, Rodrigues AM, Marques MA, Jacinto AF, Harrison Dening K, Bassett R, Moss AH, Steinberg KE, Vidal EIDO. Evaluation of the Interrater Reliability of End-of-Life Medical Orders in the Physician Orders for Life-Sustaining Treatment Form. JAMA Netw Open 2019; 2:e192036. [PMID: 30977852 PMCID: PMC6481595 DOI: 10.1001/jamanetworkopen.2019.2036] [Citation(s) in RCA: 6] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Despite its spread in much of the United States and increased international interest, the Physician Orders for Life-Sustaining Treatment (POLST) paradigm still lacks supporting evidence. The interrater reliability of the POLST form to translate patients' values and preferences into medical orders for care at the end of life remains to be studied. OBJECTIVE To assess the interrater reliability of the medical orders documented in POLST forms. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study was conducted in a public university hospital in southeastern Brazil. Two independent researchers interviewed the same patients or decision-making surrogates (n = 64) during a single episode of hospitalization within a time frame of 1 to 7 days. Eligible participants were hospitalized adults aged 21 years or older who were expected to remain hospitalized for at least 4 days and whose attending physician responded no to the question, Would I be surprised if this patient died in the next year? Data collection occurred between November 1, 2015, and September 20, 2016, and first data analyses were performed on October 3, 2016. MAIN OUTCOMES AND MEASURES Interrater reliability as measured by κ statistics. RESULTS Of the 64 participants interviewed in the study, 53 (83%) were patients and 11 (17%) were surrogates. Patients' mean (SD) age was 64 (14) years, and 35 patients (55%) and 8 surrogates (73%) were women. Overall, in 5 cases (8%), disagreement in at least 1 medical order for life-sustaining treatment was found in the POLST form, changing from the first interview to the second interview. The κ statistic for cardiopulmonary resuscitation was 0.92 (95% CI, 0.80-1.00); for level of medical intervention, 0.89 (95% CI, 0.76-1.00); and for artificially administered nutrition, 0.92 (95% CI, 0.83-1.00). CONCLUSIONS AND RELEVANCE The high interrater reliability of the medical orders in POLST forms appears to offer further support for this advance care planning paradigm; in addition, the finding that this interrater reliability was not 100% underscores the need to ensure that patients or their surrogates have decision-making capacity and to confirm that the content of POLST forms accurately reflects patients' current treatment preferences.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Rick Bassett
- Center for Nursing Excellence, St Luke’s Health System, Kansas City, Missouri
| | - Alvin H. Moss
- Center for Health Ethics and Law, West Virginia University, Morgantown
| | - Karl E. Steinberg
- Institute for Palliative Care, California State University, Long Beach
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de Oliveira Vidal EI, Silva VDS, Santos MFD, Jacinto AF, Boas PJFV, Fukushima FB. Why medical schools are tolerant of unethical behavior. Ann Fam Med 2015; 13:176-80. [PMID: 25755040 PMCID: PMC4369591 DOI: 10.1370/afm.1763] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [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: 05/24/2014] [Revised: 10/16/2014] [Accepted: 01/05/2015] [Indexed: 12/30/2022] Open
Abstract
The exposure to unethical and unprofessional behavior is thought to play a major role in the declining empathy experienced by medical students during their training. We reflect on the reasons why medical schools are tolerant of unethical behavior of faculty. First, there are barriers to reporting unprofessional behavior within medical schools including fear of retaliation and lack of mechanisms to ensure anonymity. Second, deans and directors do not want to look for unethical behavior in their colleagues. Third, most of us have learned to take disrespectful circumstances in health care institutions for granted. Fourth, the accreditation of medical schools around the world does not usually cover the processes or outcomes associated with fostering ethical behavior in students. Several initiatives promise to change that picture.
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Affiliation(s)
| | - Vanessa Dos Santos Silva
- Internal Medicine Department, Universidade Estadual Paulista (UNESP), Botucatu, Sao Paulo, Brazil
| | | | | | | | - Fernanda Bono Fukushima
- Anesthesiology Department, Universidade Estadual Paulista (UNESP), Botucatu, Sao Paulo, Brazil
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Villas Boas PJF, Spagnuolo RS, Kamegasawa A, Braz LG, Polachini do Valle A, Jorge EC, Yoo HHB, Cataneo AJM, Corrêa I, Fukushima FB, do Nascimento P, Módolo NSP, Teixeira MS, de Oliveira Vidal EI, Daher SR, El Dib R. Systematic reviews showed insufficient evidence for clinical practice in 2004: what about in 2011? The next appeal for the evidence-based medicine age. J Eval Clin Pract 2013; 19:633-7. [PMID: 22747638 DOI: 10.1111/j.1365-2753.2012.01877.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [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] [Accepted: 04/23/2012] [Indexed: 11/28/2022]
Abstract
RATIONALE AND AIM The aims of the Cochrane systematic reviews are to make readily available and up-to-date information for clinical practice, offering consistent evidence and straightforward recommendations. In 2004, we evaluated the conclusions from Cochrane systematic reviews of randomized controlled trials in terms of their recommendations for clinical practice and found that 47.83% of them had insufficient evidence for use in clinical practice. We proposed to reanalyze the reviews to evaluate whether this percentage had significantly decreased. METHODS A cross-sectional study of systematic reviews published in the Cochrane Library (Issue 7, 2011) was conducted. We randomly selected reviews across all 52 Cochrane Collaborative Review Groups. RESULTS We analyzed 1128 completed systematic reviews. Of these, 45.30% concluded that the interventions studied were likely to be beneficial, of which only 2.04% recommended no further research. In total, 45.04% of the reviews reported that the evidence did not support either benefit or harm, of which 0.8% did not recommend further studies and 44.24% recommended additional studies; the latter has decreased from our previous study with a difference of 3.59%. CONCLUSION Only a small number of the Cochrane collaboration's systematic reviews support clinical interventions with no need for additional research. A larger number of high-quality randomized clinical trials are necessary to change the 'insufficient evidence' scenario for clinical practice illustrated by the Cochrane database. It is recommended that we should produce higher-quality primary studies in active collaboration and consultation with global scholars and societies so that this can represent a major component of methodological advance in this context.
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Vidal EIO, Moreira-Filho DC, Pinheiro RS, Souza RC, Almeida LM, Camargo KR, Boas PJFV, Fukushima FB, Coeli CM. Delay from fracture to hospital admission: a new risk factor for hip fracture mortality? Osteoporos Int 2012; 23:2847-53. [PMID: 22297734 DOI: 10.1007/s00198-012-1917-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [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: 12/08/2011] [Accepted: 01/20/2012] [Indexed: 01/05/2023]
Abstract
UNLABELLED The relationship between surgical timing and hip fracture mortality is unknown in the context of developing countries where large delays to surgery are common. We observed that delay from fracture to hospital admission is associated with decreased survival after a hip fracture. INTRODUCTION To examine the relationship between the time interval from fracture to surgery as well as its subcomponents (time from fracture to hospital admission and time from admission to surgery) and hip fracture survival. METHODS The medical records of all patients aged 60 years and older admitted to a public university hospital in the city of Rio de Janeiro with a primary diagnosis of hip fracture between 1995 and 2000 were reviewed. Survival to hospital discharge and at 1 year were examined. RESULTS Among 343 patients included in the study, there were 18 (5.3%) in-hospital deaths, and 297 (86.6%) patients remained alive 1 year after surgery. Very long delays from the time of fracture to hospital admission (mean 3 days) and from hospital admission to surgery (mean 13 days) were identified. Increased time from fracture to hospital admission was associated with reduced survival to hospital discharge (hazard ratio [HR] 1.09, 95% CI 1.03-1.15, p = 0.005) and reduced survival at 1 year after surgery (HR 1.07, 95% CI 1.03-1.10, p < 0.001). The interval of time from hospital admission to surgery was not associated with reduced survival to hospital discharge (HR 1.03, 95% CI 0.96-1.10, p = 0.379) or at 1 year after surgery (HR 1.03, 95% CI 0.99-1.07, p= 0.185). CONCLUSIONS If the association estimated in our study is causal, our results provide evidence that some hip fracture-related deaths could be prevented by improved patient access to appropriate and timely hospital care in the context of a developing country.
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Affiliation(s)
- E I O Vidal
- Internal Medicine Department, Universidade Estadual Paulista (UNESP), Botucatu, Brazil.
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Rojas AC, Alves JG, Moreira e Lima R, Esther Alencar Marques M, Moreira de Barros GA, Fukushima FB, Modolo NSP, Ganem EM. The Effects of Subarachnoid Administration of Preservative-Free S(+)-Ketamine on Spinal Cord and Meninges in Dogs. Anesth Analg 2012; 114:450-5. [DOI: 10.1213/ane.0b013e31823a5d1b] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Fukushima FB, Malm C, Henry M, Gheller VA, Serakides R, Neves MM, Macedo SP, Figueiredo MS, Andrade MEJ, Chaves MS, Silva MX, Rezende CMF, Melo EG. Site of Intrauterine Artificial Insemination in the Bitch does not Affect Sperm Distribution within the Uterus. Reprod Domest Anim 2009; 45:1059-64. [DOI: 10.1111/j.1439-0531.2009.01493.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Vidal EIO, Moreira-Filho DC, Coeli CM, Camargo KR, Fukushima FB, Blais R. Hip fracture in the elderly: does counting time from fracture to surgery or from hospital admission to surgery matter when studying in-hospital mortality? Osteoporos Int 2009; 20:723-9. [PMID: 18839050 DOI: 10.1007/s00198-008-0757-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [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: 06/07/2008] [Accepted: 08/18/2008] [Indexed: 10/21/2022]
Abstract
UNLABELLED This study aims to analyze whether the interval from hospital admission to surgery may be used as a surrogate of the actual gap from fracture to surgery when investigating in-hospital hip fracture mortality. After analyzing 3,754 hip fracture admissions, we concluded that those intervals might be used interchangeably without misinterpretation bias. INTRODUCTION The debate regarding the influence of time to surgery in hip fracture (HF) mortality is one of the most controversial issues in the HF medical literature. Most previous investigations actually analyzed the time from hospital admission to surgery as a surrogate of the less easily available gap from fracture to surgery. Notwithstanding, the assumption of equivalency between those intervals remains untested. METHODS We analyzed 3,754 hospital admissions of elderly patients due to HF in Quebec, Canada. We compared the performance as predictors of in-hospital mortality of the delay from admission to surgery and the actual gap from fracture to surgery using univariate and multiple logistic regression analysis. RESULTS The mean times from fracture to surgery and from admission to surgery were 1.84 and 1.02 days (P < 0.001), respectively. On univariate logistic regression, both times were slightly significant as mortality predictors, yielding similar odds ratios of 1.08 (P < 0.001) for time from fracture to surgery and 1.11 (P < 0.001) for time from admission to surgery. After accounting for other covariates, neither times remained significant mortality predictors. CONCLUSION The gap from admission to surgery may be used as a surrogate of the actual delay from fracture to surgery when studying in-hospital HF mortality.
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Affiliation(s)
- E I O Vidal
- Social and Preventive Medicine Department, State University of Campinas, Campinas, SP, Brazil.
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