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Checketts JX, Panchal O, Stephens BJ, Patel A, Howard C, Hunt T, Reddy AK, Checketts B, Hanson C. Return to Golf After Hip Arthroscopy: A Systematic Review of the Literature. Sports Health 2024:19417381241235214. [PMID: 38581177 DOI: 10.1177/19417381241235214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2024] Open
Abstract
CONTEXT Patients experiencing pain from femoral acetabular impingement and considering hip arthroscopy may be concerned about their timeline to resume activities they enjoy, such as golf. OBJECTIVE The purpose of this study was to review current literature on return-to-play data after hip arthroscopy and to provide clinicians with data to set proper expectations with patients. DATA SOURCES The following terms were used to search PubMed and Embase electronic databases on October 18, 2023: hip, arthroscopy, arthroscopic, golf. STUDY SELECTION Studies were included if they were in the English language, of Level 1 to 4 evidence, and contained data specific to golfers undergoing hip arthroscopy. Studies were excluded if they did not designate participants as golfers or did not specify return-to-play data. Editorials, case reports, and review articles were excluded. Screening was completed by 2 authors in a blind and duplicate manner. STUDY DESIGN Systematic review. LEVEL OF EVIDENCE Level II. DATA EXTRACTION The following datapoints were extracted from each study: hip pathology and arthroscopic procedure data; number of players returning to golf and time from surgery to return; outcome score(s); and rehabilitation details. Descriptive statistics were calculated using Comprehensive Meta-Analysis software. RESULTS The search returned 400 studies, of which 4 were included for analysis. Of these 4 studies, 2 specified return-to-play time. Of 95 golfers, 90 (94.7%) returned to golf successfully after arthroscopic hip surgery. Subjective and objective outcome scores improved postoperatively, including an increased average drive distance. CONCLUSION Return to golf after hip arthroscopy is highly probable, with approximately 95% of patients throughout literature returning to play. A mean return time of 4.7 months for professional golfers and 7.2 months for amateurs, alongside improved subjective outcomes and performance metrics postsurgery, suggest patients can expect a relatively quick return to the course with similar or improved performance.
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Affiliation(s)
- Jake X Checketts
- Oklahoma State University Medical Center, Department of Orthopaedics, Tulsa, Oklahoma
| | - Olivia Panchal
- University of North Texas Health Sciences Center, Fort Worth, Texas
| | - B Joshua Stephens
- Nova Southeastern University College of Medicine, Fort Lauderdale, Florida
| | - Amar Patel
- Oklahoma State University Medical Center, Department of Orthopaedics, Tulsa, Oklahoma
| | - Conner Howard
- Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma
| | - Tyler Hunt
- Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania
| | - Arjun K Reddy
- Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma
| | | | - Chad Hanson
- Oklahoma State University Medical Center, Department of Orthopaedics, Tulsa, Oklahoma and Oklahoma State University, Department of Sports Medicine, Stillwater, Oklahoma
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Howard C, Sell T, Abraham C, Anderson JM, Norris B, Anderson RM, Vu TK, Vassar M, Checketts JX. Inadequate harms reporting among randomized controlled trials cited as supporting evidence in the AAOS management of hip fractures in older adults clinical practice guideline recommendations. Injury 2024; 55:111326. [PMID: 38262332 DOI: 10.1016/j.injury.2024.111326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 11/11/2023] [Accepted: 01/12/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUND Recommendations within clinical practice guidelines (CPGs) are heavily influenced by results from randomized controlled trials (RCTs). Therefore, it is imperative that all RCT outcomes are reported thoroughly to ensure CPGs are created using accurate information. Here, we evaluate the quality of harms reporting using the CONSORT Extension for Harms in RCTs underpinning recommendations in the American Academy of Orthopedic Surgeons (AAOS) Management of Hip Fractures in Older Adults CPG. METHODS Each RCT cited as evidence for recommendations in the AAOS Management of Hip Fractures in Older Adults CPG was evaluated using the CONSORT Extension for Harms to determine the quality of harms reporting. Descriptive statistics (frequencies, percentages, 95 % confidence intervals) were used to summarize adherence to CONSORT Harms items. A linear regression model was used to evaluate the CONSORT Harms influence on the quality of reporting over time. RESULTS Among the 156 RCTs identified, there were a total of 31,848 participants. Most RCTs were conducted at a single center (137; 87.8 %) and in a single-blind manner (130; 83.3 %). Fifty-four (34.6 %) RCTs did not provide funding statements. Trials adequately reported an average of 6.65 out of 18 CONSORT Extension for Harms items (37.0 %). One RCT adequately reported all items, while five reported zero items. Forty-seven RCTs (30.1 %) reported ≥ 50 % of items and 73 (46.8 %) reported ≤ 33.3 % of items. The linear regression model demonstrated no significant increase in mean adherence over time (adjusted R2 = -0.006; p = 0.563). CONCLUSION Our results highlight inadequate harms reporting among RCTs in the AAOS Management of Hip Fractures in Older Patients CPG. While the CONSORT Harms Extension was intended to enhance reporting, the linear regression model did not demonstrate significant improvements over time.
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Affiliation(s)
- Conner Howard
- Oklahoma State University, Center for Health Sciences, Tulsa, OK, USA.
| | - Tianna Sell
- Burrell College of Osteopathic Medicine, Las Cruces, NM, USA
| | - Christena Abraham
- Kansas City University College of Osteopathic Medicine, Kansas City, MO, USA
| | - J Michael Anderson
- Oklahoma State University Medical Center, Department of Orthopaedic Surgery, Tulsa, OK, USA
| | - Brent Norris
- Oklahoma State University Medical Center, Department of Orthopaedic Surgery, Tulsa, OK, USA; Orthopaedic Trauma Services of Oklahoma, Tulsa, OK, USA
| | - Reece M Anderson
- Oklahoma State University, Center for Health Sciences, Tulsa, OK, USA
| | - Thuc K Vu
- Kansas City University College of Osteopathic Medicine, Kansas City, MO, USA
| | - Matt Vassar
- Oklahoma State University, Center for Health Sciences, Tulsa, OK, USA
| | - Jake X Checketts
- Oklahoma State University Medical Center, Department of Orthopaedic Surgery, Tulsa, OK, USA
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Hill M, Allen C, Williamson TK, Martinez V, Vangeli S, Zaheer A, Kingery MT, Checketts JX. Top 50 most impactful publications on massive rotator cuff tears. JSES Rev Rep Tech 2024; 4:20-32. [PMID: 38323204 PMCID: PMC10840572 DOI: 10.1016/j.xrrt.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Background Bibliometric analysis is a useful tool for measuring the scholarly impact of a topic and its more and less heavily studied aspects. The purpose of this study is to use bibliometric analysis to comprehensively analyze the 50 articles with the highest citation indices in studies evaluating the treatment and outcomes of massive rotator cuff tears (mRCTs). Methods This cross-sectional study identified articles within the Scopus database published through December 2022. Keywords used were "massive rotator cuff tear." Articles were sorted in chronological order. The year published and number of citations were recorded. A citation index (CI) was calculated for each article by dividing the number of citations by number of years published [1 citation/1 year published (2021) = CI of 1]. Of these, the 50 articles with the highest CIs were carried forward for evaluation. Frequencies and distributions were assessed for data of each variable collected. Results These search methods produced 625 articles regarding mRCT research (ranging from January 1986 to December 2022). Four of the top 10 most impactful articles were published in the 2010s. The level of evidence (LOE) published with the greatest frequency was level of evidence 4 (41%). The journal Arthroscopy published the highest number within the top 50 (26%) followed by the Journal of Bone and Joint Surgery and the American Journal of Sports Medicine (20% each). Clinical studies composed 88% of the top 50. Case series (38%) predominated, while systematic reviews (20%) and randomized control trials (8%) were less prevalent. The majority of studies concentrated on the clinical outcomes of certain interventions (62%), mainly comparing multiple interventions. Conclusion Despite the relatively high prevalence of mRCTs (40% of all tears), this topic comprises only a small proportion of all rotator cuff research. This analysis has identified gaps within and limitations of the findings concerning mRCTs for researchers to propose research questions targeting understudied topics and influence the future treatment and outcomes of this clinically difficult diagnosis.
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Affiliation(s)
- Marcheta Hill
- University of the Incarnate Word School of Osteopathic Medicine, San Antonio, TX, USA
| | - Christian Allen
- University of the Incarnate Word School of Osteopathic Medicine, San Antonio, TX, USA
| | - Tyler K. Williamson
- Department of Orthopaedic Surgery, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Victor Martinez
- University of the Incarnate Word School of Osteopathic Medicine, San Antonio, TX, USA
| | - Sydney Vangeli
- University of the Incarnate Word School of Osteopathic Medicine, San Antonio, TX, USA
| | - Aroob Zaheer
- University of the Incarnate Word School of Osteopathic Medicine, San Antonio, TX, USA
| | - Matthew T. Kingery
- Department of Orthopaedic Surgery, NYU Langone Medical Center, New York, NY, USA
| | - Jake X. Checketts
- Department of Orthopaedic Surgery, Oklahoma State University Medical Center, Tulsa, OK, USA
- St Francis Medical Center, Tulsa, OK, USA
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Hughes GK, Checketts JX. To the Editor: Reporting Limitations Misses the Mark to Reshape the Residency "Research Arms Race". J Grad Med Educ 2024; 16:96-97. [PMID: 38304591 PMCID: PMC10829922 DOI: 10.4300/jgme-d-23-00809.1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Affiliation(s)
- Griffin K Hughes
- Graduate Student, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Jake X Checketts
- Resident Physician, Department of Orthopaedic Surgery, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
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Martinez VH, Zaheer A, McCarrell J, Checketts JX, Hanson CD. Education Research in Orthopaedic Surgery. JB JS Open Access 2023; 8:JBJSOA-D-22-00090. [PMID: 37025186 PMCID: PMC10072309 DOI: 10.2106/jbjs.oa.22.00090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Abstract
With the ever-changing dynamics of surgical training, it is essential for the content of educational research to evolve simultaneously. This study aimed to assess the current state of scholarly work in orthopaedic training education and to identify particular educational topics that are trending in the literature.
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Affiliation(s)
- Victor H. Martinez
- School of Osteopathic Medicine, University of the Incarnate Word, San Antonio, Texas
- E-mail address for V.H. Martinez:
| | - Aroob Zaheer
- School of Osteopathic Medicine, University of the Incarnate Word, San Antonio, Texas
| | - Jerod McCarrell
- School of Osteopathic Medicine, University of the Incarnate Word, San Antonio, Texas
| | - Jake X. Checketts
- Department of Orthopaedic Surgery, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma
| | - Chad D. Hanson
- Department of Orthopaedic Surgery, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma
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Kelly EA, Forootan NS, Checketts JX, Frank A, Tangen CL. Retrospective analysis of whole-body cryotherapy adverse effects in Division I collegiate athletes. J Osteopath Med 2023; 123:249-257. [PMID: 36927611 DOI: 10.1515/jom-2022-0156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 02/09/2023] [Indexed: 03/17/2023]
Abstract
CONTEXT Although the physiological effects and the performance of athletes after utilizing whole-body cryotherapy (WBC) have been widely studied, there is a lack of data on its adverse effects. It is important to be aware of the adverse effects of any treatment for its use to be properly recommended. OBJECTIVES This study aims to provide insight to any adverse effects that collegiate athletes experienced after utilizing WBC to better utilize this therapeutic modality. METHODS After the Institutional Review Board (IRB) deemed exemption, all 457 Division 1-A varsity athletes were recruited via email to participate in a retrospective survey. Participants consented to the study by continuing to the questions. The inclusion criteria were that they must be 18 years of age or older, had completed WBC at that university, and were a student-athlete. The survey was six questions long, and if any of the inclusion criteria was not met, they were redirected to end the survey. The data were analyzed utilizing odds ratios. RESULTS Of the 457 student-athletes, 11.2% (n=51) responded and 6.3% (n=29) met the inclusion criteria. Responses were obtained from women's lacrosse (27.6%; n=8), women's gymnastics (24.1%, n=7), field hockey (17.2%, n=5), wrestling (6.9%, n=2), football (6.9%, n=2), women's cross country (3.5%, n=1), men's basketball (3.5%, n=1), women's volleyball (3.5%, n=1), softball (3.5%, n=1), and baseball (3.5%, n=1). Among the responses, 79.3% (n=23) were females and 29.7% (n=6) were males. Within 1 h of WBC, the most frequently reported adverse effects were skin rash (27.6%, n=8), itching (13.8%, n=4), and fatigue (6.9%, n=2). More than 1 h after WBC, the most frequently reported adverse effects were skin rash (20.7%, n=6), itching (10.3%, n=3), and increased energy (6.9%, n=2). When stratified by female and male athletes, for both within 1 h and more than 1 h after WBC, there were increased odds for females reporting adverse effects; however, neither were statistically significant (OR 4.58, p=0.19, 95% CI 0.46 to 45.61) (OR 3.84, p=0.25, 95% CI 0.39 to 38.36). Within 1 h of WBC, 58.6% (n=17) of subjects reported no adverse effects, and more than 1 h after WBC, 65.5% (n=19) subjects reported no adverse effects. The mean satisfaction level rating was 6.34 (range 0-10, n=29). When asked if they would do WBC again, 65.5% (n=19) responded "yes" and 34.5% (n=10) responded "no." CONCLUSIONS In this collegiate athlete population, negative adverse effects of WBC commonly included skin burns and itching while potentially proving a beneficial adverse effect of increased energy. Subjects commonly reported no adverse effects after WBC treatment as well.
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Affiliation(s)
- Emily A Kelly
- Department of Medicine, Lake Erie College of Osteopathic Medicine, Erie, PA, USA
| | | | - Jake X Checketts
- Department of Orthopedic Surgery, Oklahoma State Medical Center, Tulsa, OK, USA
| | - Austin Frank
- Athletic Training Department, Kent State University, Kent, OH, USA
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Reddy AK, Scott JT, Norris GR, Moore C, Checketts JX, Hughes GK, Small T, Calder MM, Norris BL. Cemented vs Uncemented hemiarthroplasties for femoral neck fractures: An overlapping systematic review and evidence appraisal. PLoS One 2023; 18:e0281090. [PMID: 36827316 PMCID: PMC9955942 DOI: 10.1371/journal.pone.0281090] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 01/17/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND The purpose of our study is to assess the methodology of overlapping systematic reviews related to cemented vs uncemented hip hemiarthroplasties for the treatment of femoral neck fractures to find the study with the best evidence. Also, we assess the gaps in methodology and information to help with direction of future studies. METHODS A systematic search was conducted in September 2022 using Pubmed, Embase, and Cochrane Library. Clinical outcome data and characteristics of each study were extracted to see which treatment had better favorability. The outcomes and characteristics extracted from each study includes, first author, search date, publication journal and date, number of studies included, databases, level of evidence, software used, subgroup analyses that were conducted, and heterogeneity with the use of I2 statistics Methodological quality information was extracted from each study using four different methodologic scores (Oxford Levels of Evidence; Assessment of Multiple Systematic Reviews (AMSTAR); Quality of reporting of meta-analyses (QUROM); Oxman and Guyatt. After that, the Jadad decision algorithm was used to identify which studies in our sample contained the best available evidence. Finally, overlap of each systematic review was assessed using Corrected Covered Area (CCA) to look at redundancy and research waste among the systematic reviews published on the topic. RESULTS After screening, 12 studies were included in our sample. For the Oxford Levels of Evidence, we found that all the studies were Level I evidence. For the QUORUM assessment, we had 1 study with the highest score of 18. Additionally, we did the Oxman and Guyatt assessment, where we found 4 studies with a maximum score of 6. Finally, we did an AMSTAR assessment and found 2 studies with a score of 9. After conducting the methodological scores; the authors determined that Li. L et al 2021 had the highest quality. In addition, it was found that the CCA found among the primary studies in each systematic review calculated to .22. Any CCA above .15 is considered "very high overlap". CONCLUSIONS The best available evidence suggests that Cemented HAs are better at preventing Prosthesis-related complications. Conversely, the best evidence also suggests that Cemented HA also results in longer operative time and increased intraoperative blood loss. When conducting future systematic reviews related to the topic, we ask that authors restrict conducting another systematic review until new evidence emerges so as not to confuse the clinical decision-making of physicians.
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Affiliation(s)
- Arjun K. Reddy
- Department of Orthopaedic Surgery, Oklahoma State University Medical Center, Tulsa, Oklahoma
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma
| | - Jared T. Scott
- Department of Orthopaedic Surgery, Oklahoma State University Medical Center, Tulsa, Oklahoma
| | - Grayson R. Norris
- Department of Orthopaedic Surgery, Oklahoma State University Medical Center, Tulsa, Oklahoma
| | - Chip Moore
- Department of Orthopaedic Surgery, Oklahoma State University Medical Center, Tulsa, Oklahoma
| | - Jake X. Checketts
- Department of Orthopaedic Surgery, Oklahoma State University Medical Center, Tulsa, Oklahoma
| | - Griffin K. Hughes
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma
| | - Travis Small
- Department of Orthopaedic Surgery, Oklahoma State University Medical Center, Tulsa, Oklahoma
| | - Mark M. Calder
- Department of Orthopaedic Surgery, Oklahoma State University Medical Center, Tulsa, Oklahoma
- Orthopaedic & Trauma Service of Oklahoma, Tulsa, Oklahoma
- Department of Orthopaedic Trauma, The University of Oklahoma at Tulsa School of Community Medicine, Tulsa, Oklahoma
| | - Brent L. Norris
- Department of Orthopaedic Surgery, Oklahoma State University Medical Center, Tulsa, Oklahoma
- Orthopaedic & Trauma Service of Oklahoma, Tulsa, Oklahoma
- Department of Orthopaedic Trauma, The University of Oklahoma at Tulsa School of Community Medicine, Tulsa, Oklahoma
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Reddy AK, Lulkovich K, Wirtz A, Thompson JC, Scott JT, Checketts JX, Ottwell R, Hanson CD, Hartwell M, Vassar M. Assessment of Spin in the Abstracts of Systematic Reviews and Meta-analyses on Platelet-Rich Plasma Treatment in Orthopaedics: A Cross-sectional Analysis. Orthop J Sports Med 2023; 11:23259671221137923. [PMID: 36814771 PMCID: PMC9940191 DOI: 10.1177/23259671221137923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
Background Systematic reviews on the use of platelet-rich plasma (PRP) in orthopaedic surgery are abundant in current published literature. However, a beautification of results (referred to as spin) has been noted in abstracts across various aspects of medicine. Purpose To determine the prevalence of spin in systematic reviews of PRP-related orthopaedic surgery abstracts. Study Design Cross-sectional study. Methods Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and Murad and Wang guidelines, we conducted a search in Medline, Embase, and the Cochrane Database for reviews on PRP-related orthopaedic surgery. The search included studies published from inception until June 30, 2021. Included were systematic reviews written in English that involved the use of PRP in the treatment of orthopaedic injuries in human participants. The abstracts of the included reviews were evaluated for the top 9 types of spin as described by Yavchitz et al in 2016. We determined the relationship between spin and study characteristics using odds ratios. Results Of an initial 1560 studies, 176 were included. We found that 50 studies (28.4%) contained at least 1 form of spin. The 2 most common forms of spin found in our sample were type 5 ("Conclusion claims the beneficial effect of treatment despite high risk of bias"; n = 27 [15.3%]) and type 3 ("Selective reporting or overemphasis of efficacy in outcomes favoring beneficial effect of intervention"; n = 18 [10.2%]). No statistical significance was found between study characteristics and the presence of spin. Conclusion Spin was present in 28% of the systematic reviews that covered PRP-related orthopaedic treatments. Spin was not associated with general study characteristics, including adherence to PRISMA guidelines or funding. Journals and authors should be aware of spin in articles and avoid its usage.
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Affiliation(s)
- Arjun K. Reddy
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA.,Department of Orthopedic Surgery, Oklahoma State University Medical Center, Tulsa, Oklahoma, USA.,Arjun K. Reddy, BA, Oklahoma State University Center for Health Sciences, 1111 W 17th St, Tulsa, OK 74107, USA () (Twitter: @ArjunKot918)
| | - Kaley Lulkovich
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Alexis Wirtz
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Jay C. Thompson
- Department of Orthopedic Surgery, Oklahoma State University Medical Center, Tulsa, Oklahoma, USA
| | - Jared T. Scott
- Department of Orthopedic Surgery, Oklahoma State University Medical Center, Tulsa, Oklahoma, USA
| | - Jake X. Checketts
- Department of Orthopedic Surgery, Oklahoma State University Medical Center, Tulsa, Oklahoma, USA
| | - Ryan Ottwell
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Chad D. Hanson
- Department of Orthopedic Surgery, Oklahoma State University Medical Center, Tulsa, Oklahoma, USA
| | - Micah Hartwell
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences at The Cherokee Nation, Tahlequah, Oklahoma, USA
| | - Matt Vassar
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
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Checketts JX, Steele R, Patel A, Stephens J, Buhrke K, Reddy A, Stallings L, Triplet JJ, Chalkin B. Clinical and functional outcomes of reverse total shoulder arthroplasty supplemented with latissimus dorsi transfer: a systematic review and meta-analysis. JSES Rev Rep Tech 2023; 3:28-36. [PMID: 37588073 PMCID: PMC10426461 DOI: 10.1016/j.xrrt.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Background To optimize patients' functional external rotation outcomes, reverse total shoulder arthroplasties (rTSAs) including a latissimus dorsi tendon transfer were undertaken with promising early results and no significant increase in complications in comparison to traditional rTSAs. This was especially utilized for patients with a pronounced combined loss of elevation and external rotation. The purpose of this study is to evaluate and synthesize the findings of all relevant publications assessing the outcomes of rTSAs with associated latissimus dorsi transfer. Methods We thoroughly searched the literature within the PubMed database using a standardized methodology. For our inclusion criteria, we included any study regarding rTSAs that contained functional outcome scores for postoperative range of motion (such as elevation, external rotation, etc.) or postoperative outcomes such as complications (reoperation, infection, etc.) and patient satisfaction. For the extraction of data, we used pilot-tested Google Forms to record extracted data. These data were then converted to spreadsheets (Microsoft Excel [Microsoft, Redmond, WA, USA]). This was done on 2 separate scenarios by 2 authors to ensure accuracy. We used the modified Coleman Methodology Score to assess the methodological quality of the studies in our samples. Meta-analysis mathematics and statistical analysis were performed using Stata software 17 (StataCorp, College Station, TX, USA). Results Our search returned a total of 12 studies containing data of 213 shoulders receiving RTSAs with a latissimus dorsi transfer. Functional outcomes were available for 160 shoulders. The mean preoperative elevation of the affected shoulder was 73.57 degrees, and the mean postoperative elevation was 141.80 degrees. For external rotation, the mean preoperative average was -6.71 degrees, and the mean postoperative average was 22.73 degrees. The absolute Constant score average was 31.56 preoperatively, while the postoperative value was 68.93. In our sample, 25 patients (11.73%) required a revision of the RTSA implant due to complications. Discussion Combined loss of elevation and external rotation can be a severely debilitating condition for those with a glenohumeral pathology. Latissimus dorsi transfer for this condition has been proven to be an effective modality. The reoperation and complication rate appears to be sizable, and as such surgeons should consider this when considering this modality for their patients.
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Affiliation(s)
- Jake X. Checketts
- Oklahoma State University Medical Center, Department of Orthopaedic Surgery, Tulsa, OK, USA
| | - Robert Steele
- Kansas City University College of Medicine, Kansas City, MO, USA
| | - Ashini Patel
- Nova Southeastern University College of Medicine, Ft. Lauderdale, FL, USA
| | - Josh Stephens
- Nova Southeastern University College of Medicine, Ft. Lauderdale, FL, USA
| | - Kate Buhrke
- Idaho College of Osteopathic Medicine, Boise, ID, USA
| | - Arjun Reddy
- Oklahoma State University Medical Center, Department of Orthopaedic Surgery, Tulsa, OK, USA
- Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - Landon Stallings
- Oklahoma State University Medical Center, Department of Orthopaedic Surgery, Tulsa, OK, USA
| | - Jacob J. Triplet
- Mayo Clinic, Department of Orthopaedic Surgery, Rochester, MO, USA
| | - Brian Chalkin
- Oklahoma State University Medical Center, Department of Orthopaedic Surgery, Tulsa, OK, USA
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10
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Shepard S, Sajjadi NB, Checketts JX, Hughes G, Ottwell R, Chalkin B, Hartwell M, Vassar M. Examining the Public's Most Frequently Asked Questions About Carpal Tunnel Syndrome and Appraising Online Information About Treatment. Hand (N Y) 2022:15589447221142895. [PMID: 36564990 DOI: 10.1177/15589447221142895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. Patients often search online for health information regarding common musculoskeletal complaints. Thus, the purpose of this study was to use language processing information from Google to assess the content of CTS frequently asked questions (FAQs) searched online and the transparency and quality of online CTS information. METHODS On March 11, 2021, we searched Google for 3 terms "carpal tunnel syndrome treatment," "carpal tunnel syndrome surgical treatment," and "carpal tunnel syndrome non-surgical treatment" until a minimum of 100 FAQs and their answer links were extracted from each search. We used Rothwell classification to categorize the FAQs. The Journal of the American Medical Association's benchmark criteria were used to assess information transparency. Information quality was assessed using the Brief DISCERN tool. RESULTS Our Google search returned 124 unique FAQs. Fifty-six (45.2%) were value based and most were related to the evaluation of treatment options (45/56, 80.4%). The most common source type was medical practices (26.6%). Nearly half of the answer sources (45.9%) were found to be lacking in transparency. One-way analysis of variance revealed a significant difference in mean Brief DISCERN scores among the 5 source types, F(4, 119) = 5.93, P = .0002, with medical practices averaging the worst score (13.73/30). CONCLUSIONS Patients are most commonly searching Google to gain information regarding CTS treatment options. Online sources such as medical practices should use widely accepted rubrics for ensuring transparency and quality prior to publishing CTS information.
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Affiliation(s)
- Samuel Shepard
- Oklahoma State University Center for Health Sciences, Tulsa, USA
| | | | | | - Griffin Hughes
- Oklahoma State University Center for Health Sciences, Tulsa, USA
| | | | - Brian Chalkin
- Oklahoma State University Medical Center, Tulsa, USA
| | - Micah Hartwell
- Oklahoma State University Center for Health Sciences, Tulsa, USA
| | - Matt Vassar
- Oklahoma State University Center for Health Sciences, Tulsa, USA
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Reddy AK, Norris GR, Nayfa R, Sajjadi NB, Checketts JX, Scott JT, Hartwell M. The presence of person-centered language in orthopedic-related amputation research: a cross-sectional analysis. J Osteopath Med 2022; 123:235-242. [PMID: 36520046 DOI: 10.1515/jom-2022-0181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 11/08/2022] [Indexed: 12/23/2022]
Abstract
Abstract
Context
Amputations are routine in orthopedics, specifically during trauma and when patients have recurrent surgical site infections. When undergoing amputations, patients must combat the psychosocial factors associated with the loss of an extremity, including stigmatization.
Objectives
This study analyzes the presence of person-centered language (PCL) within amputation-related orthopedic publications in the top orthopedic journals.
Methods
We conducted a cross-sectional analysis with a database search on February 14, 2021 utilizing PubMed. Utilizing a previously published search string, we isolated studies that were published in the top 20 orthopedic journals based on the Google h5-index. In addition to the top 20 orthopedic journals, we included the top two hand and foot & ankle journals in our search to incorporate more amputation literature. Our search yielded 687 returns. The sample was then randomized, and the first 300 studies that fit our inclusion criteria were examined for prespecified non-PCL terminology.
Results
Our results show that 157 (52.2%) studies were adherent to PCL according to the American Medical Association’s Manual of Style 10th Edition (AMAMS). Of the 143 (47.7%) studies that were not adherent to PCL, 51 studies (35.7%) had more than one type of non-PCL language. The term “amputee,” which is being labeled as identity-first language (IFL), was found in 101 articles (33.7%). Further investigation found that 73.3% (74/101) of the studies containing IFL were found to have other non-PCL terms. Of the other studies in the sample, non-PCL was found 34.7% (88/199) of the time. This analysis was done due to the discrepancies in stigmatization of the term “amputee.” No statistical association was found between adherence to PCL and study characteristics.
Conclusions
Our findings show that amputation literature within the top orthopedic journals has limited adherence to PCL. Additionally, the use of the term “amputee,” which is widely accepted by the amputation community, resulted in a greater rate of non-PCL terminology within orthopedic amputation literature. Efforts should be implemented within orthopedics to avoid the use of stigmatizing language, regarding individuals that underwent amputations, to minimize psychosocial stressors.
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Affiliation(s)
- Arjun K. Reddy
- Department of Orthopedic Surgery , Oklahoma State University Medical Center , Tulsa , OK , USA
- Office of Medical Student Research , Oklahoma State University Center for Health Sciences , Tulsa , OK , USA
| | - Grayson R. Norris
- Department of Orthopedic Surgery , Oklahoma State University Medical Center , Tulsa , OK , USA
| | - Rob Nayfa
- Department of Orthopedic Surgery , Oklahoma State University Medical Center , Tulsa , OK , USA
| | - Nicholas B. Sajjadi
- Office of Medical Student Research , Oklahoma State University Center for Health Sciences , Tulsa , OK , USA
| | - Jake X. Checketts
- Department of Orthopedic Surgery , Oklahoma State University Medical Center , Tulsa , OK , USA
| | - Jared T. Scott
- Department of Orthopedic Surgery , Oklahoma State University Medical Center , Tulsa , OK , USA
| | - Micah Hartwell
- Office of Medical Student Research , Oklahoma State University Center for Health Sciences at Cherokee Nation , Tahlequah , OK , USA
- Department of Psychiatry and Behavioral Sciences , Oklahoma State University Center for Health Sciences , Tulsa , OK , USA
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12
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Anderson JM, Howard C, Staggs J, Steele R, Strasser T, Small T, Vassar M, Checketts JX. Inadequate Reporting of Complications in Randomized Controlled Trials Cited as Supporting Evidence Underpinning AAOS CPG Recommendations for Hip and Knee Osteoarthritis: Application of the CONSORT Harms Checklist. J Arthroplasty 2022; 37:2466-2472.e2. [PMID: 35709908 DOI: 10.1016/j.arth.2022.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 06/05/2022] [Accepted: 06/07/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Randomized controlled trials (RCTs) have been shown to influence clinical decision-making and health policy. Therefore, it is essential that trial outcomes-including harms-are completely reported. METHODS We included all RCTs cited as supporting evidence for the American Academy of Orthopaedic Surgeons Surgical Management of Osteoarthritis of the Knee, Osteoarthritis of the Knee, and Osteoarthritis of theHip Clinical Practice Guideline recommendations. Manuscripts were analyzed for compliance with the Consolidated Standards of Reporting Trials (CONSORT) Extension for Harms items. We determined the Extension for Harms' influence on harms reporting by comparing RCTs published before and after the extension's release. RESULTS One hundred and seventy-three RCTs were included, of which 81 (47%) adequately reported ≥50% of the checklist and 75 (43%) reported ≤33% of the checklist items. The mean number of checklist items reported was 8 items (of 18; 45%). Our interrupted time-series analysis suggests the implementation of the CONSORT Extension for Harms did not have a statistically significant effect on the completeness of harms reporting (P = .35; 95% Confidence interval = -0.0041 to 0.0014). CONCLUSION Harms-related data are poorly reported within RCTs cited as supporting evidence for the American Academy of Orthopaedic Surgeons management for hip and knee OA Clinical Practice Guideline. Our time series analysis illustrates the failure of the CONSORT Extension for Harms on improving the reporting of harms-related data. Future efforts to improve the quality of harms reporting is crucial for patients, clinicians, and policy makers to perform thorough risk-benefit appraisals as RCT results directly influence clinical decision-making in orthopaedic surgery.
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Affiliation(s)
- J Michael Anderson
- Department of Orthopaedic Surgery, Oklahoma State University Medical Center, Tulsa, Oklahoma
| | - Conner Howard
- Oklahoma State University, Center for Health Sciences, Tulsa, Oklahoma
| | - Jordan Staggs
- Oklahoma State University, Center for Health Sciences, Tulsa, Oklahoma
| | - Robert Steele
- Kansas City University Medicine and Biosciences, Kansas City, Missouri
| | - Thomas Strasser
- Kansas City University Medicine and Biosciences, Kansas City, Missouri
| | - Travis Small
- Department of Orthopaedic Surgery, Oklahoma State University Medical Center, Tulsa, Oklahoma
| | - Matt Vassar
- Oklahoma State University, Center for Health Sciences, Tulsa, Oklahoma
| | - Jake X Checketts
- Department of Orthopaedic Surgery, Oklahoma State University Medical Center, Tulsa, Oklahoma
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13
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Reddy AK, Checketts JX, Stephens BJ, Anderson JM, Cooper CM, Hunt T, Fishbeck K, Boose M, Detweiler B, Chalkin B, Norris BL. Complication and revision rates after reverse total shoulder revision from hemiarthroplasty: a systematic review. Shoulder Elbow 2022; 14:481-490. [PMID: 36199509 PMCID: PMC9527483 DOI: 10.1177/17585732211019390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 05/02/2021] [Accepted: 05/03/2021] [Indexed: 01/17/2023]
Abstract
Background Thus, the purpose of the present study was to (1) characterize common postoperative complications and (2) quantify the rates of revision in patients undergoing hemiarthroplasty to reverse total shoulder arthroplasty revisional surgery. We hypothesize that hardware loosenings will be the most common complication to occur in the sample, with the humeral component being the most common loosening. Methods This systematic review adhered to PRISMA reporting guideline. For our inclusion criteria, we included any study that contained intraoperative and/or postoperative complication data, and revision rates on patients who had undergone revision reverse total shoulder arthroplasty due to a failed hemiarthroplasty. Complications include neurologic injury, deep surgical site infections, hardware loosening/prosthetic instability, and postoperative fractures (acromion, glenoid, and humeral fractures). Results The study contained 22 studies that assessed complications from shoulders that had revision reverse total shoulder arthroplasty from a hemiarthroplasty, with a total sample of 925 shoulders. We found that the most common complication to occur was hardware loosenings (5.3%), and of the hardware loosenings, humeral loosenings (3.8%) were the most common. The revision rate was found to be 10.7%. Conclusion This systematic review found that revision reverse total shoulder arthroplasty for failed hemiarthroplasty has a high overall complication and reintervention rates, specifically for hardware loosening and revision rates.
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Affiliation(s)
- Arjun K Reddy
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - Jake X Checketts
- Department of Orthopedic Surgery, Oklahoma State University Medical Center, Tulsa, OK, USA
| | | | - J Michael Anderson
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - Craig M Cooper
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - Tyler Hunt
- Lake Erie College of Osteopathic Medicine, Erie, PA, USA
| | - Keith Fishbeck
- Department of Orthopedic Surgery, Oklahoma State University Medical Center, Tulsa, OK, USA
| | - Marshall Boose
- Department of Orthopedic Surgery, Oklahoma State University Medical Center, Tulsa, OK, USA
| | - Byron Detweiler
- Department of Orthopedic Surgery, Oklahoma State University Medical Center, Tulsa, OK, USA
| | - Brian Chalkin
- Department of Orthopedic Surgery, Oklahoma State University Medical Center, Tulsa, OK, USA
| | - Brent L Norris
- Department of Orthopedic Surgery, Oklahoma State University Medical Center, Tulsa, OK, USA
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14
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Reddy AK, Scott JT, Joshua Stephens B, Patel A, Checketts JX, Stotler WM, Hawkins BJ, Vassar M. Evaluation of Proposed Protocol Changing Statistical Significance From 0.05 to 0.005 in Foot and Ankle Randomized Controlled Trials. J Foot Ankle Surg 2022; 61:925-926. [PMID: 35367112 DOI: 10.1053/j.jfas.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 03/17/2022] [Indexed: 02/03/2023]
Affiliation(s)
- Arjun K Reddy
- Department of Orthopedic Surgery, Oklahoma State University Medical Center, Tulsa, OK; Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK.
| | - Jared T Scott
- Department of Orthopedic Surgery, Oklahoma State University Medical Center, Tulsa, OK
| | - B Joshua Stephens
- Department of Orthopedic Surgery, Oklahoma State University Medical Center, Tulsa, OK
| | - Ashini Patel
- Department of Orthopedic Surgery, Oklahoma State University Medical Center, Tulsa, OK
| | - Jake X Checketts
- Department of Orthopedic Surgery, Oklahoma State University Medical Center, Tulsa, OK
| | - Wesley M Stotler
- Department of Orthopedic Surgery, Oklahoma State University Medical Center, Tulsa, OK
| | - Bryan J Hawkins
- Department of Orthopedic Surgery, Oklahoma State University Medical Center, Tulsa, OK
| | - Matt Vassar
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK; Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, OK
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15
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Reddy AK, Checketts JX, Scott JT, Norris GR, Norris BL. Network meta-analysis: What is its purpose in Orthopaedic literature? Injury 2022:S0020-1383(22)00435-1. [PMID: 35798576 DOI: 10.1016/j.injury.2022.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 06/20/2022] [Indexed: 02/02/2023]
Abstract
Systematic reviews, of level-I primary literature, are the gold standard for the formation of Clinical Practice Guidelines in Orthopaedic Surgery. When systematic reviews have multiple groups of data, meta-analyses can be conducted to analyse the direct comparison of the data points (pairwise meta-analysis). Over recent years, statisticians have created a new statistical model called network meta-analyses that can be applied to systematic reviews. network meta-analyses allow for comparison of different treatment outcomes that may or may not have been directly assessed through level-I primary studies. network meta-analyses are appearing more and more in Orthopaedic Surgery literature; therefore, in this article, we discuss what a Network Meta-analysis is and its application in Orthopaedics.
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Affiliation(s)
- Arjun K Reddy
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, 1111W 17th St., Tulsa, OK, USA; Department of Orthopedic Surgery, Oklahoma State University Medical Center, Tulsa, OK, USA.
| | - Jake X Checketts
- Department of Orthopedic Surgery, Oklahoma State University Medical Center, Tulsa, OK, USA
| | - Jared T Scott
- Department of Orthopedic Surgery, Oklahoma State University Medical Center, Tulsa, OK, USA
| | - Grayson R Norris
- Department of Orthopedic Surgery, Oklahoma State University Medical Center, Tulsa, OK, USA
| | - Brent L Norris
- Department of Orthopedic Surgery, Oklahoma State University Medical Center, Tulsa, OK, USA; Orthopaedic & Trauma Services of Oklahoma, Tulsa, OK, USA
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16
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Checketts JX, Scott J, Fishbeck K, Hart T, Pham W, Dadgar A, Calder M, Norris BL. Reoperation and Complication Rates Following Patellar Fracture Repair with Plates: A Retrospective Analysis with Patient-Reported Outcomes at More than 1 Year of Follow-up. JB JS Open Access 2022; 7:JBJSOA-D-22-00012. [PMID: 35620525 PMCID: PMC9116955 DOI: 10.2106/jbjs.oa.22.00012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Recent work has suggested good clinical and functional results with dorsal surface plating of patellar fractures. The primary outcome measurement of this study was reoperation rates for patellar fractures that had been treated with dorsal plating. Methods This work consists of a retrospective review of clinical and functional outcome data following repair of patellar fractures with dorsal plates. We obtained institutional review board approval for this study and conducted a review of 9 consecutive years of our group's trauma practice. We also contacted patients to assess patient-reported outcomes (PROs) after 12 months. Results Eighty-five patellar fractures were treated with open reduction and internal fixation (ORIF) via plating over 9 years. Eight (9.41%) of the patients required reoperation. Of the 72 patients with complete follow-up of ≥12 weeks, 3 (4.17%) had nonunion of the fracture site and 4 (5.56%) had loss of reduction of the fracture. The average Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score among our sample was 18.84 (slight symptoms); 72.41% of the patients in our sample had slight or no symptoms at ≥12 months postoperatively. Conclusions Our results indicated that plating of comminuted patellar fractures is a safe, viable treatment strategy. The PROs at ≥12 months of follow-up data were promising. Additionally, dorsal plating may allow for early return of function and less postoperative bracing. Level of Evidence Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Jake X. Checketts
- Department of Orthopaedic Surgery, Oklahoma State University Medical Center, Tulsa, Oklahoma,Email for corresponding author:
| | - Jared Scott
- Department of Orthopaedic Surgery, Oklahoma State University Medical Center, Tulsa, Oklahoma
| | - Keith Fishbeck
- Department of Orthopaedic Surgery, Oklahoma State University Medical Center, Tulsa, Oklahoma
| | - Thomas Hart
- University of Oklahoma College of Medicine, Tulsa, Oklahoma
| | - William Pham
- University of Oklahoma College of Medicine, Tulsa, Oklahoma
| | - Azad Dadgar
- Department of Orthopaedic Surgery, Oklahoma State University Medical Center, Tulsa, Oklahoma,University of Oklahoma College of Medicine, Tulsa, Oklahoma,Orthopaedic & Trauma Services of Oklahoma, Tulsa, Oklahoma
| | - Mark Calder
- Department of Orthopaedic Surgery, Oklahoma State University Medical Center, Tulsa, Oklahoma,University of Oklahoma College of Medicine, Tulsa, Oklahoma,Orthopaedic & Trauma Services of Oklahoma, Tulsa, Oklahoma
| | - Brent L. Norris
- Department of Orthopaedic Surgery, Oklahoma State University Medical Center, Tulsa, Oklahoma,University of Oklahoma College of Medicine, Tulsa, Oklahoma,Orthopaedic & Trauma Services of Oklahoma, Tulsa, Oklahoma
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17
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Checketts JX, Hunt T, Checketts BR, Scott JT, Johnson M, Boose M, Schwartz M, Chalkin B. Analysis of Social Media Perceptions Among Orthopaedic Surgery Residency Applicants and Social Media Use by Residency Programs During the 2020 to 2021 Cycle. JB JS Open Access 2021; 6:JBJSOA-D-21-00083. [PMID: 34957367 PMCID: PMC8691490 DOI: 10.2106/jbjs.oa.21.00083] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Owing to the coronavirus 2019 pandemic limiting both applicants and residency programs in their ability to connect in-person, it is likely that a shift toward virtual connections was made. We aimed to query applicants regarding their perspectives of orthopaedic residency program social media use. Furthermore, we aimed to quantify the number of orthopaedic surgery residency programs with active social media accounts.
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Affiliation(s)
- Jake X Checketts
- Department of Orthopaedic Surgery, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma
| | - Tyler Hunt
- Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania
| | | | - Jared T Scott
- Department of Orthopaedic Surgery, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma
| | - Mark Johnson
- Department of Orthopaedic Surgery, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma
| | - Marshall Boose
- Department of Orthopaedic Surgery, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma
| | - Mark Schwartz
- Department of Orthopaedic Surgery, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma
| | - Brian Chalkin
- Department of Orthopaedic Surgery, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma
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18
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Hanson CD, Thompson JC, Checketts JX, Beason DP, Pille C, Lemak L. Increased Bite Distance From the Edge Lowers Risk of Pullout of Simple Sutures from Acellular Dermal Allograft. Arthrosc Sports Med Rehabil 2021; 3:e1513-e1516. [PMID: 34712988 PMCID: PMC8527321 DOI: 10.1016/j.asmr.2021.06.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 06/29/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose To investigate whether pullout strength in the acellular dermal allograft matrix (ADM) used for superior capsule reconstruction depends on the distance from the edge of the graft. Methods ADM used for superior capsule reconstruction was obtained and cut into 30 squares. Two sutures were placed through the center of each graft by using a loaded Keith needle and forming a simple stitch. The grafts were divided into 3 groups of 10 grafts with a distance of 5 mm, 10 mm or 15 mm from the closest edge of the graft, respectively. The grafts were then preloaded to 5 N and pulled to failure at a rate of 12 mm/s on an MTS 858 MiniBionix servohydraulic mechanical test frame. The load to failure was recorded as well as the stiffness of each graft. Results The mean load to failure was 34.5 N (SD 7.89) for the 5 mm grafts, 31.7 N (SD 5.99) for the 10 mm grafts, and 66.2 N (SD 18.4) for the 15 mm grafts. There was a significant difference (< 0.0001) between the large grafts (15 mm) and the 2 smaller grafts (10 mm, 5 mm). There was no significant difference in stiffness between the groups of graft (P 0.40). Conclusion Placing the suture at least 15 mm from the edge of the graft increases the graft's ultimate yield strength to suture pullout. Clinical Relevance The depths of the suture in ADM could improve pullout strength for constructs of superior capsular reconstructions.
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Affiliation(s)
- Chad D Hanson
- Oklahoma State University Medical Center, Department of Orthopaedic Surgery, Tulsa, Oklahoma
| | - Jay C Thompson
- Oklahoma State University Medical Center, Department of Orthopaedic Surgery, Tulsa, Oklahoma
| | - Jake X Checketts
- Oklahoma State University Medical Center, Department of Orthopaedic Surgery, Tulsa, Oklahoma
| | - David P Beason
- American Sports Medicine Institute, Lemak Health, Birmingham, Alabama, U.S.A
| | - Craig Pille
- American Sports Medicine Institute, Lemak Health, Birmingham, Alabama, U.S.A
| | - Lawrence Lemak
- American Sports Medicine Institute, Lemak Health, Birmingham, Alabama, U.S.A
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19
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Evans S, Anderson JM, Johnson AL, Checketts JX, Scott J, Middlemist K, Fishbeck K, Vassar M. The Potential Effect of Lowering the Threshold of Statistical Significance From P < .05 to P < .005 in Orthopaedic Sports Medicine. Arthroscopy 2021; 37:1068-1074. [PMID: 33253798 DOI: 10.1016/j.arthro.2020.11.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 02/12/2020] [Revised: 11/14/2020] [Accepted: 11/14/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine how changing the P value threshold of statistical significance from .05 to .005 could affect the statistical significance of findings in previously published orthopaedic sports medicine randomized controlled trials (RCTs). METHODS The authors searched PubMed from January 1, 2016, to December 31, 2017, for RCTs published in the American Journal of Sports Medicine, Arthroscopy, and Knee Surgery, Sports Traumatology, Arthroscopy. Data were extracted blinded and in duplicate fashion by 2 of us. The authors then extracted P value data for primary end points, since RCTs are most often powered for these end points. Discrepancies were resolved by consensus. Google Forms were used for data extraction and STATA 15.1 for the data analysis. RESULTS In total, 275 primary end points were identified from 132 trials. Analysis of primary end points found 45.8% (126/275) had a P value less than .05 and were classified as statistically significant under the current threshold, whereas 54.2% (149/275) had a P value greater than .05 and were not classified as suggestive. Of those end points that were previously considered statistically significant, 38.9% (49/126) were less than .005, whereas 61.1% (77/126) were between .005 and .05 and thereby would be reclassified as suggestive rather than statistically significant under the proposed threshold. Overall, when analyzing the 275 primary end points, we found only 49 (17.8%) of the end points were less than .005 and would hold statistical significance with the proposed threshold. CONCLUSIONS The results suggest that if the threshold of statistical significance were to change to .005, the significance of orthopaedic sports medicine RCTs would be heavily altered. The authors also acknowledge the many issues research faces in regard to P value reliability and therefore interpretation of study results. Because P values from RCTs can often influence the ways physicians choose interventions, it is important to implement methodology that decreases incidence of bias and misrepresentation of these results. However, the authors also understand that lowering the P value could increase the needed sample size and by consequence increase study costs as well, while not directly correlating to clinical significance. Thus, the authors recommend that this proposed threshold should be further evaluated and cautiously interpreted. CLINICAL RELEVANCE If the statistical significance threshold is changed, clinical practice guideline recommendations also may be affected.
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Affiliation(s)
- Sheridan Evans
- Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, U.S.A..
| | - J Michael Anderson
- Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, U.S.A
| | - Austin L Johnson
- Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, U.S.A
| | - Jake X Checketts
- Department of Orthopaedic Surgery, Oklahoma State University Medical Center, Tulsa, Oklahoma, U.S.A
| | - Jared Scott
- Department of Orthopaedic Surgery, Oklahoma State University Medical Center, Tulsa, Oklahoma, U.S.A
| | - Kevin Middlemist
- Department of Orthopaedic Surgery, Oklahoma State University Medical Center, Tulsa, Oklahoma, U.S.A
| | - Keith Fishbeck
- Department of Orthopaedic Surgery, Oklahoma State University Medical Center, Tulsa, Oklahoma, U.S.A
| | - Matt Vassar
- Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, U.S.A
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20
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Thompson JC, Price CM, Checketts JX, Hanson C, Torgerson T, Hartwell M, Vassar MB. An analysis of Google Trends following athletic injuries by high profile NBA players during the 2019 NBA finals. J Osteopath Med 2021; 121:551-554. [PMID: 33711226 DOI: 10.1515/jom-2020-0269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 02/04/2021] [Indexed: 11/15/2022]
Abstract
CONTEXT Injuries are common among high profile players in the National Basketball Association (NBA), and could provide an opportunity for physicians to provide accurate sports injury information and reliable rehabilitation data to the general public in the immediate aftermath. OBJECTIVES To evaluate social media trends to investigate public interest in athletic injuries in the NBA and to evaluate the length of maintained interest in these injuries. METHODS The Google Trends tool was used to analyze search data around two high profile players-Kevin Durant and Klay Thompson-who suffered injuries during the 2019 NBA Finals. The results were compared to the expected search forecast derived from an autoregressive integrated moving algorithm model. RESULTS Both players were associated with a mean increase of 1,052.4% (standard deviation [SD], 703.96%) in relative search volumes for terms related to their injuries. This data showed a significant increase in search engine activity related to injuries associated with NBA players in the first 6.13 days (SD, 3.14 days) following the injuries, marking a substantial timeframe for public engagement. CONCLUSIONS Search traffic information may be beneficial to the sports medicine community, as social media can provide a platform for patient education in a limited timeframe. By increasing patient awareness and knowledge regarding athletic injuries, social media can expand the pool of potential patients for physicians and surgeons.
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Affiliation(s)
- Jay C Thompson
- Department of Orthopedic Surgery in Oklahoma, Oklahoma State University Medical Center, Tulsa, OK, USA
| | - Christopher M Price
- Department of Institutional Research in Oklahoma, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - Jake X Checketts
- Department of Orthopedic Surgery in Oklahoma, Oklahoma State University Medical Center, Tulsa, OK, USA
| | - Chad Hanson
- Department of Orthopedic Surgery in Oklahoma, Oklahoma State University Medical Center, Tulsa, OK, USA
| | - Trevor Torgerson
- Department of Institutional Research in Oklahoma, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - Micah Hartwell
- Department of Institutional Research in Oklahoma, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - Matt B Vassar
- Department of Institutional Research in Oklahoma, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
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21
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Reddy AK, Scott J, Checketts JX, Fishbeck K, Boose M, Stallings L, Vassar M. Levels of evidence backing the AAOS clinical practice guidelines. Journal of Orthopaedics, Trauma and Rehabilitation 2021. [DOI: 10.1177/2210491721992533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Purpose: The American Academy of Orthopaedic Surgeons produces clinical practice guidelines for the treatment of orthopedic injuries. We examined the strength of the evidence underlying these recommendations in order to answer the following questions: (1) Have AAOS work groups improved guideline creation practices to locate evidence to generate strong recommendations? (2) Is there variability in the available evidence based on anatomic site or stage of care? (3) Has the level of evidence supporting improved over time? Methods: Twenty-two current guidelines of the Academy were examined which yielded 408 individual recommendations. These recommendations were assigned one of five strength of evidence ratings (strong, moderate, limited, inconclusive, consensus) by the guideline panel, based on the availability and quality of the supporting evidence. From these guidelines, we extracted all of the recommendations and their corresponding evidence ratings. We then classified the recommendations by stage of care, year, and anatomical site. Results: The distribution of the levels of evidence was as follows: 77 (18.9%) were based on consensus; 53 (13.0%) were inconclusive; 93 (22.8%) were based on limited evidence; 112 (27.5%) were based on moderate evidence; and 73 were based on (17.9%) strong evidence. Strong strength of evidence was found in 45.2% of the recommendations for preventive/screening/diagnostic care, 41.1% of nonsurgical treatment, 45.1% of surgical treatment, 51.1% of rehabilitation/postoperative treatment, and 45.5% of the recommendations that had mixed stages of care. Inconclusive strength of evidence was found to be prevalent from 2009–2013, but was eliminated starting in 2014. Conclusions: Only 73 (17.9%) recommendations generated by the Academy in its 22 clinical practice guidelines are based on a “strong” strength of evidence. More robust research is needed in orthopedics to bolster confidence in the recommendations in future guideline updates.
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Affiliation(s)
- Arjun K Reddy
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - Jared Scott
- Department of Orthopedic Surgery, Oklahoma State University Medical Center, Tulsa, OK, USA
| | - Jake X Checketts
- Department of Orthopedic Surgery, Oklahoma State University Medical Center, Tulsa, OK, USA
| | - Keith Fishbeck
- Department of Orthopedic Surgery, Oklahoma State University Medical Center, Tulsa, OK, USA
| | - Marshall Boose
- Department of Orthopedic Surgery, Oklahoma State University Medical Center, Tulsa, OK, USA
| | - Landon Stallings
- Department of Orthopedic Surgery, Oklahoma State University Medical Center, Tulsa, OK, USA
| | - Matt Vassar
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
- Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
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Cooper CM, Gray H, Barcenas L, Torgerson T, Checketts JX, Vassar M. An Evaluation of Reporting Guidelines and Clinical Trial Registry Requirements Among Addiction Medicine Journals. J Osteopath Med 2020; 120:823-830. [PMID: 33075122 DOI: 10.7556/jaoa.2020.148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Context Robust methodology and ethical reporting are paramount for quality scientific research, but recently, that quality in addiction research has been questioned. Avenues to improve such research quality include adherence to reporting guidelines and proper usage of clinical trial registries. Reporting guidelines and clinical trial registries have been shown to lead researchers to more ethical and transparent methodology. Objectives To investigate the reporting guideline and clinical trial registration policies of addiction research journals and identify areas of improvement. Methods We used Google Scholar Metrics' h-5 index to identify the top 20 addiction research journals. We then examined the instructions for authors from each journal to identify whether they required, recommended, or made no mention of trial registration and reporting guidelines, including the Consolidated Standards of Reporting Trials (CONSORT), Meta-Analysis of Observational Studies in Epidemiology (MOOSE), Quality of Reporting of Meta-analyses (QUOROM), Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), Standards for Reporting Diagnostic Accuracy Studies (STARD), Strengthening the Reporting of Observational Studies in Epidemiology (STROBE), Animal Research: Reporting of In Vivo Experiments (ARRIVE), Case Reports (CARE), Consolidated Health Economic Evaluation Reporting Standards (CHEERS), Standards for Reporting Qualitative Research (SRQR), Standards for Quality Improvement Reporting Excellence (SQUIRE), Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT), Consolidated Criteria for Reporting Qualitative Research (COREQ), Transparent Reporting of a Multivariate Prediction Model for Individual Prognosis or Diagnosis (TRIPOD), Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P), and the International Committee of Medical Journal Editors (ICMJE) guidelines. We performed the same analysis regarding requirements for clinical trial registration. Results Of the 20 journals included in this study, 10 journals (50%) did not require adherence to any reporting guidelines. Trial registration followed a similar trend; 15 journals (75%) did not mention any form of trial or systematic review registration, and ClinicalTrials.gov was only recommended by only 1 journal (5%). Conclusions Among top addiction medicine journals, required adherence to reporting guidelines and clinical trial registry policies remains substandard. A step toward fulfilling the National Institute on Drug Abuses' call for improvement in transparency and reproducibility within addiction research should include all journals adopting a strict reporting guideline and clinical trial registry adherence policy.
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Wright MR, Frye L, Vo Solis L, Checketts JX, Guevara C, Smith L, Vassar M. Evaluating Financial Conflicts of Interest Among Contributors to Clinical Practice Guidelines of the American College of Obstetricians and Gynecologists. J Osteopath Med 2020; 120:462-470. [DOI: 10.7556/jaoa.2020.059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Abstract
Context
Patient care is an essential part of the practice of obstetrics and gynecology, and patient care is directed by clinical practice guidelines. To increase the validity of these guidelines, we must make sure that there is no outside influence by financial conflicts of interest.
Objective
To investigate the existence of and reporting patterns regarding payments received by contributors to guidelines from the American College of Obstetricians and Gynecologists (ACOG), ACOG executive committee members, and companies making these payments and to examine the compliance of those receiving payments to ACOG's conflict of interest policies.
Methods
The Center for Medicare and Medicaid's Open Payments database was used to search practice bulletin committee members and practice bulletin collaborators from 2014-2016, as well as current executive committee board members. Open Payments was also used to evaluate companies that provided payments, and amounts were totaled. The main outcome measure was the monetary values of payments received and the compliance with disclosure statements enforced by ACOG. Manufacturer payments to physicians in the database were analyzed descriptively.
Results
General and research payments were calculated among 65 physicians in the Open Payments database: 44 physician members of both the obstetrics and the gynecology practice bulletin committees, 4 2016 ACOG executive board physician members, and 17 contributing physician authors. Research payments accounted for greater than 78% of all payments. Consulting, travel and lodging, and speaking fees totaled greater than $90,000 and contributed to more than 90% of the total amount of general payments. Food and beverage payments contributed to 10% of all general payments. Three covered members were noncompliant with the financial conflicts of interest guidelines, receiving industry payments exceeding $5000.
Conclusion
A small number of companies provide the majority of contributions; however, there is no evidence to suggest bias toward manufactures within ACOG practice bulletins. Future investigations into pharmaceutical manufacturer payments, specifically for consulting fees, may be warranted. (Clinical Trial Registry UMIN-CTR, UMIN000029165)
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Johnson AL, Walters C, Gray H, Torgerson T, Checketts JX, Boose M, Norris B, Vassar M. The use of systematic reviews to justify orthopaedic trauma randomized controlled trials: A cross-sectional analysis. Injury 2020; 51:212-217. [PMID: 31711650 DOI: 10.1016/j.injury.2019.11.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 11/04/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Orthopaedic trauma is one of the largest surgical fields in medicine, and as such, requires the latest evidence to ensure the best standard of care. Systematic reviews are an invaluable resource that compiles an exhaustive summary of the most current evidence on a given clinical question. The primary aim of this study is to evaluate the use of systematic reviews as justification in conducting randomized controlled trials published in high impact orthopaedic trauma journals. METHODS We analyzed randomized controlled trials published in the top three high impact orthopaedic trauma journals between 2015 and 2018. We performed data extraction blind, independent, and in duplicative manner to ensure the validity of the findings. For each trial, data was extracted by the number of systematic reviews cited in each clinical trial and whether or not the study used a systematic review as justification for conducting the trial. A subgroup of general orthopaedic clinical trials were included for comparison. RESULTS Of 144 articles retrieved, 128 were included. Overall, 71.1% (91/128; [95% CI, 63.2-78.9]) of included orthopaedic trauma randomized controlled trials referenced a systematic review and 28.9% (37/128) of studies did not cite a systematic review. Of the 91 trials that referenced a systematic review, 33.0% (30/91; [95% CI, 23.3-42.6]) of RCTs cited a systematic review as trial justification, whether that be "verbatim" or "inferred". "Verbatim" justifications occurred in 20.0% (6/30; [95% CI, 5.7-34.3]) of included trauma RCTs that cited a systematic review as justification for conducting the trial and "inferred" justifications occurred in 80.0% (24/30; [95% CI, 65.7-94.3]). CONCLUSION Systematic reviews are frequently cited in orthopaedic trauma RCTs but are not commonly cited as justification for conducting a clinical trial. Ideally, evidentiary uncertainty regarding a research question should be established by existing literature through a systematic review to reduce research waste.
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Affiliation(s)
- Austin L Johnson
- Oklahoma State University Center for Health Sciences, Tulsa, OK, United States.
| | - Corbin Walters
- Oklahoma State University Center for Health Sciences, Tulsa, OK, United States
| | - Harrison Gray
- Oklahoma State University Center for Health Sciences, Tulsa, OK, United States
| | - Trevor Torgerson
- Oklahoma State University Center for Health Sciences, Tulsa, OK, United States
| | - Jake X Checketts
- Oklahoma State University Center for Health Sciences, Tulsa, OK, United States
| | - Marshall Boose
- Oklahoma State University Medical Center, Department of Orthopaedics, Tulsa, OK, United States
| | - Brent Norris
- Oklahoma State University Medical Center, Department of Orthopaedics, Tulsa, OK, United States; Orthopaedic & Trauma Services of Oklahoma, Tulsa, OK, United States
| | - Matt Vassar
- Oklahoma State University Center for Health Sciences, Tulsa, OK, United States
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Fishbeck K, Checketts JX, Cooper CM, Scott JT, Vassar M. Evaluation of the Clarity and Completeness of Reporting in Orthopedic Clinical Practice Guidelines. J Osteopath Med 2020; 120:74-80. [PMID: 31985766 DOI: 10.7556/jaoa.2020.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Clinical practice guidelines (CPGs) can positively affect the quality of patient care offered by physicians because they decrease variability in clinical practice and may help reduce unnecessary testing, promoting a more responsible use of resources. Building on existing framework for reporting guideline development, including the work of the Enhancing the Quality and Transparency of Health Research Network, the Reporting Items for Practice Guidelines in Healthcare (RIGHT) Working Group created a 2016 checklist of 35 items considered essential for high-quality reporting of CPGs. Objectives To evaluate how many previously published CPGs in orthopedic surgery met the RIGHT criteria and assess how improvements can be made in future orthopedic CPGs based on any found deficiencies. Methods All 18 CPGs published before January 1, 2018, by the American Academy of Orthopedic Surgeons (AAOS) are publicly available on orthoguidelines.org. Two authors downloaded each file and both of those authors independently scored each CPG using piloted abstraction RIGHT checklist forms. Results Of the 35 RIGHT criteria outlined in 22 checklist items, 23 (65.7%) were met across all AAOS guidelines, 6 (17.1%) were not met by any of the AAOS guidelines, and 6 (17.2%) were met by some of the AAOS guidelines. Conclusion Overall, the AAOS guidelines addressed many important recommendations within the RIGHT checklist. Assessing adherence to the RIGHT checklist can help ensure that future guidelines are more effectively communicated, hopefully assisting end users in efficient implementation and increasing the level of evidence-based patient care.
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Arthur W, Zaaza Z, Checketts JX, Johnson AL, Middlemist K, Basener C, Jellison S, Wayant C, Vassar M. Analyzing Spin in Abstracts of Orthopaedic Randomized Controlled Trials with Statistically Insignificant Primary Endpoints. Arthroscopy 2020; 36:1443-1450.e1. [PMID: 31954806 DOI: 10.1016/j.arthro.2019.12.025] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 12/12/2019] [Accepted: 12/13/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE Our primary aim of our study is to evaluate the prevalence of spin among abstracts in orthopaedic randomized controlled trials (RCTs) with nonsignificant primary endpoints. METHODS This study was conducted in accordance with a previously written protocol publicly available via the Open Science Framework. PubMed (which includes Medline) was searched for RCTs in orthopaedic surgery. The articles that were identified were then uploaded to Rayyan, and the abstracts were screened for inclusion. To be included, a trial had to have randomized the patients for intervention, statistically compare multiple groups, and had a primary endpoint that was not significant. Odds ratios and summary statistics (frequencies and proportions) were then calculated for spin in the abstracts. RESULTS Of the 780 articles retrieved from our search string, 250 articles met the inclusion criteria. Analysis resulted in 112/250 (44.80%; [95% CI, 38.64-50.96]) RCTs that containing spin within the abstract. Of the 112 RCTs, 52 (46.43%; [95% CI, 37.19-55.66]) had spin in the results, and 89 (79.46%; [95% CI, 71.98-86.95]) had spin in the conclusion of the abstract. The Journal of Bone and Joint Surgery was found to have the highest prevalence of spin (21/37, 56.76% [95% CI, 40.79%-72.72%]) while Arthroscopy: The Journal of Arthroscopic & Related Surgery had the lowest prevalence of spin (5/15, 33.33% [95% CI, 9.48%-57.19%]). No correlation was found between industry funding and increased odds of spin in the abstract (uOR, 1.10; 95% CI, 0.45-2.63). Discrepancies for our primary endpoint, prevalence of spin among abstracts, were analyzed with Gwet's AC1 inter-rater statistic and found to be 81% [95% CI, 0.75-0.87]. CONCLUSION Spin was found in 44.8% of the abstracts within our sample of orthopaedic RCTs. Nonsignificant primary data were often represented to seem significant, many orthopaedic RCTs did not indicate primary endpoints, and orthopaedic RCTs infrequently reported trial registration.
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Affiliation(s)
- Wade Arthur
- Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, U.S.A
| | - Zachariah Zaaza
- Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, U.S.A
| | - Jake X Checketts
- Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, U.S.A
| | - Austin L Johnson
- Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, U.S.A..
| | - Kevin Middlemist
- Oklahoma State University Medical Center, Tulsa, Oklahoma, U.S.A
| | - Clint Basener
- Oklahoma State University Medical Center, Tulsa, Oklahoma, U.S.A
| | - Sam Jellison
- Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, U.S.A
| | - Cole Wayant
- Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, U.S.A
| | - Matt Vassar
- Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, U.S.A
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Johnson AL, Evans S, Checketts JX, Scott JT, Wayant C, Johnson M, Norris B, Vassar M. Effects of a proposal to alter the statistical significance threshold on previously published orthopaedic trauma randomized controlled trials. Injury 2019; 50:1934-1937. [PMID: 31421816 DOI: 10.1016/j.injury.2019.08.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 08/10/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION A recent proposal suggests changing the threshold for statistical significance from a P value of .05 to .005 to minimize bias and increase reproducibility of future studies. P values less than .05 but greater than .005 would be reclassified as "suggestive", whereas P values less than .005 would be considered significant. The present study explores how lowering the P value threshold would affect the interpretation of previously published orthopaedic trauma randomized controlled trials (RCTs) and whether outcomes from these trials would maintain statistical significance under the proposed P value threshold. METHODS All RCTs published between January 01, 2016 and January 31, 2018 in the Journal of Orthopaedic Trauma, Injury, and Archives of Orthopaedic and Trauma Surgery were screened by at least 2 authors. Data from included trials were extracted in blinded and duplicate fashion. All P values for primary endpoints were included from each study. RESULTS We identified 124 primary endpoints from 48 trials: 39.5% (49/124) of endpoints had a P value less than .05 and 60.5% (75/124) had a P value greater than .05. Overall, 51.0% (25/49) of statistically significant primary endpoints were less than .005, while 49.0% (24/49) would be reclassified as suggestive. CONCLUSION Based on our results, adopting a lower threshold of significance would heavily alter the significance of orthopaedic trauma RCTs and should be further evaluated and cautiously considered when viewing the effect such a proposal on orthopaedic practice.
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Affiliation(s)
- Austin L Johnson
- Oklahoma State University Center for Health Sciences, Tulsa, OK, United States.
| | - Sheridan Evans
- Oklahoma State University Center for Health Sciences, Tulsa, OK, United States
| | - Jake X Checketts
- Oklahoma State University Center for Health Sciences, Tulsa, OK, United States
| | - Jared T Scott
- Oklahoma State University Center for Health Sciences, Tulsa, OK, United States; Oklahoma State University Medical Center - Department of Orthopaedics, Tulsa, OK, United States
| | - Cole Wayant
- Oklahoma State University Center for Health Sciences, Tulsa, OK, United States
| | - Mark Johnson
- Oklahoma State University Medical Center - Department of Orthopaedics, Tulsa, OK, United States
| | - Brent Norris
- Orthopaedic & Trauma Services of Oklahoma, Tulsa, OK, United States; Oklahoma State University Medical Center - Department of Orthopaedics, Tulsa, OK, United States
| | - Matt Vassar
- Oklahoma State University Center for Health Sciences, Tulsa, OK, United States; Oklahoma State University Medical Center - Department of Orthopaedics, Tulsa, OK, United States
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Norris GR, Checketts JX, Scott JT, Vassar M, Norris BL, Giannoudis PV. Prevalence of Deep Surgical Site Infection After Repair of Periarticular Knee Fractures: A Systematic Review and Meta-analysis. JAMA Netw Open 2019; 2:e199951. [PMID: 31441940 PMCID: PMC6714463 DOI: 10.1001/jamanetworkopen.2019.9951] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [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: 01/06/2023] Open
Abstract
IMPORTANCE Surgical management of periarticular knee fractures can be challenging, and adverse outcomes may be severe. Recent literature indicates that the rate of periarticular knee surgical site infection (SSI) may range from 2% to 88% depending on the fracture site. OBJECTIVE To examine the prevalence of deep SSI and the rate of septic arthritis after surgical repair of fractures around the knee. DATA SOURCES The electronic databases MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched from their inception to July 1, 2018. STUDY SELECTION Eligible studies had to specifically report deep SSI rates and include fractures in the distal femur, patella, tibial plateau, or proximal tibia. Risk factors that were associated with increased the risk of deep SSI were also examined. DATA EXTRACTION AND SYNTHESIS This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Data were extracted by multiple investigators. Comprehensive Meta-Analysis software was used for the pooling of data, using either random-effects or fixed-effects models, with respect to the degree of statistical heterogeneity present. Data analyses were conducted in October 2019. MAIN OUTCOMES AND MEASURES The primary outcome was overall prevalence of deep SSI after periarticular knee fracture repair. The secondary outcomes were the overall prevalence of septic arthritis, risk factors associated with deep SSI, and the most commonly cultured bacteria specimens found periarticular knee infections. RESULTS Of 6928 articles screened, 117 articles met inclusion criteria and were included in analysis. Among 11 432 patients included in analysis, 653 patients (5.7%) experienced deep SSIs, most commonly among patients with proximal tibia fractures (56 of 872 patients [6.4%]). Among studies that included information on septic arthritis, 38 of 1567 patients (2.4%) experienced septic arthritis. The 2 most commonly reported bacteria were methicillin-resistant Staphylococcus aureus, found in 67 SSIs, and methicillin-susceptible S aureus, found in 53 SSIs. Sixty-two studies (53.0%) in the sample received a Coleman Methodological Score of poor (<50 points). CONCLUSIONS AND RELEVANCE Deep SSIs occurred in nearly 6% of periarticular knee fracture repairs, and 2.4% of SSIs were associated with septic arthritis. Surgeons managing these injuries should be vigilant when wounds are not pristine. Efforts should be made to elevate the quality of research conducted not only in this subject but also in orthopedic surgery as a whole.
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Affiliation(s)
| | | | - Jared T. Scott
- Oklahoma State University Center for Health Sciences, Tulsa
- Department of Orthopedics, Oklahoma State University Center for Health Sciences, Tulsa
| | - Matt Vassar
- Oklahoma State University Center for Health Sciences, Tulsa
| | - Brent L. Norris
- Department of Orthopedics, Oklahoma State University Center for Health Sciences, Tulsa
- Orthopedic & Trauma Services of Oklahoma, Tulsa
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Meyer C, Bowers A, Heavener TE, Checketts JX, Vassar M. From clinical practice guideline development to trial registration: A systematic investigation of research pipeline for inflammatory bowel disease. Indian J Gastroenterol 2019; 38:247-262. [PMID: 31270778 DOI: 10.1007/s12664-019-00965-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 05/21/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Clinical practice guidelines help practitioners manage patients in an effective and systematic way, and they assist in making evidence-based decisions related to diagnosis and treatment. Each recommendation is ranked based on evidence. The goal of this study is to determine gaps in research for inflammatory bowel diseases (IBD) by using the low-level evidence recommendations. METHODS We extracted low-level evidence recommendations set forth by the American College of Gastroenterology in IBD, ulcerative colitis (UC), and Crohn's disease. ClinicalTrials.gov , the World Health Organization's International Clinical Trials Registry Platform and PubMed were then used to locate studies relevant to the recommendations. RESULTS There were 30 low-level evidence recommendations, and 23 had recent or ongoing studies addressing them. We screened 2938 trials and 4321 published articles, 221 of which addressed low-quality recommendations. There were five recommendations that received the majority of research attention (143/221, 65%). CONCLUSION This study used clinical practice guidelines to help determine areas of needed research in IBD, UC, and Crohn's disease. By searching trial registries and articles indexed on PubMed, we identified the extent to which studies were being conducted to address research gaps. Of the gaps identified, five recommendations received most of the attention. While most of the significant gaps had some recent or ongoing research, our study found several areas where investigation is still needed. Clinical practice guidelines are an effective method to prioritize future research.
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Affiliation(s)
- Chase Meyer
- Center for Health Sciences, Oklahoma State University, 1111 W 17th Street, Tulsa, OK, 74107, USA
| | - Aaron Bowers
- Center for Health Sciences, Oklahoma State University, 1111 W 17th Street, Tulsa, OK, 74107, USA
| | - Trace E Heavener
- Department of Internal Medicine, Baylor Scott and White Medical Center-Temple, 2401 South 31st Street, Temple, TX, 76508, USA.
| | - Jake X Checketts
- Center for Health Sciences, Oklahoma State University, 1111 W 17th Street, Tulsa, OK, 74107, USA
| | - Matt Vassar
- Center for Health Sciences, Oklahoma State University, 1111 W 17th Street, Tulsa, OK, 74107, USA
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Checketts JX, Riddle J, Zaaza Z, Boose MA, Whitener JH, Vassar MB. An Evaluation of Spin in Lower Extremity Joint Trials. J Arthroplasty 2019; 34:1008-1012. [PMID: 30733070 DOI: 10.1016/j.arth.2019.01.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 12/20/2018] [Accepted: 01/08/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Spin is a specific type of reporting bias that misrepresents data and results within randomized controlled trials (RCTs). Because spin may provide a surgeon with an inaccurate representation of trial results, thus misconstruing the surgeons' interpretation thereof and possibly negatively affecting patient care, it is important that spin is identified within publications. The primary goal of our study was to determine the prevalence of spin found within the abstracts of lower extremity joint trials. METHODS Using Google Scholar's H-5 index, we selected the top 20 journals in the orthopedic surgery category. We then conducted a PubMed search on July 2nd, 2018 using the advanced search feature, encompassing all RCTs published in these journals from January 1, 2016 to January 1, 2017. Spin was evaluated using a standardized protocol, using a previously published protocol on the Open Science Network. RESULTS Our final sample consisted of 46 trials published in 9 of the top 20 orthopedic surgery journals. Spin was found in 27 (58.7%) of the 46 abstracts. Evidence of spin in the abstract results was found in 19 (41.3%) of the 46 articles, and spin in abstract conclusions was found in 15 (32.6%) of the 46 articles. CONCLUSIONS Our study found that a significant number of lower extremity joint RCTs contain one or more form of spin in either their abstract results, conclusions, or both. In addition, our investigation revealed that a sizable portion of these lower extremity orthopedic joint RCTs are not registered or do not report their registration, and funding sources are also underreported.
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Affiliation(s)
| | - Jonathan Riddle
- Oklahoma State University Center for Health Sciences, Tulsa, OK
| | - Zach Zaaza
- Oklahoma State University Center for Health Sciences, Tulsa, OK
| | - Marshall A Boose
- Department of Orthopaedic Surgery, Oklahoma State University Medical Center, Tulsa, OK
| | - Jake H Whitener
- Department of Orthopaedic Surgery, Oklahoma State University Medical Center, Tulsa, OK
| | - Matt B Vassar
- Oklahoma State University Center for Health Sciences, Tulsa, OK
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Abstract
Background: Statistical analysis of systematic reviews allows the results of previous studies to be combined and synthesized to assess the overall health effect of the intervention in question. Systematic reviews can also be used to guide the creation of clinical practice guidelines and are considered to have a high level of evidence. Thus, it is important that their methodological quality is of the highest standard. Publication bias presents 2 problems: (1) studies with significant results may be overrepresented in systematic reviews and meta-analyses (“false positives”) and (2) studies without significant results may not be included in systematic reviews and meta-analyses (“false negatives”) because each study, on its own, was underpowered, meaning that some treatment options that may have clinical benefit will not be adopted. Methods: We performed a study to evaluate the techniques used by authors to report and evaluate publication bias in the top 10 orthopaedic journals as well as 3 orthopaedic-related Cochrane groups. Two authors independently screened the titles and abstracts to identify systematic reviews and meta-analyses. We assessed publication bias in the systematic reviews that did not assess publication bias themselves. Results: Our final sample included 694 systematic reviews or meta-analyses that met our inclusion criteria. Our review included 502 studies (72%) that focused on clinical outcomes, with the majority of the remaining studies focused on predictive and prognostic accuracy (20%) or diagnostic accuracy (5%). Publication bias was discussed in 295 (42.5%) of the included studies and was assessed in 135 (19.5%). Of the studies that assessed publication bias, 31.9% demonstrated evidence of publication bias. Only 43% and 22% of studies that involved use of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines discussed and assessed publication bias, respectively. Conclusions: Publication bias is infrequently discussed and assessed in the high-impact orthopaedic literature. Furthermore, nearly one-third of the studies that assessed for publication bias demonstrated evidence of publication bias. In addition to these shortcomings, fewer than half of these studies involved use of the PRISMA guidelines and yet only one-fourth of the studies assessed for publication bias. Clinical Relevance: By understanding the degree to which publication bias is discussed and presented in high-impact orthopaedic literature, changes can be made by journals and researchers alike to improve the overall quality of research produced and reported.
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Affiliation(s)
- Jared Scott
- Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma
| | - Jake X Checketts
- Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma
| | - Craig M Cooper
- Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma
| | - Marshall Boose
- Department of Orthopaedic Surgery, Oklahoma State University Medical Center, Tulsa, Oklahoma
| | - Cole Wayant
- Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma
| | - Matt Vassar
- Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma
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Jaiswal D, Checketts JX, Vassar M. Industry Payments in Cardiology: A Cross-sectional Analysis of Open Payments Data. J Osteopath Med 2018; 118:781-787. [DOI: 10.7556/jaoa.2018.170] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Abstract
Background
The goal of Open Payments and the Physician Payments Sunshine Act is to foster transparency and accountability to help stakeholders better understand financial ties between physicians and teaching hospitals and the pharmaceutical and medical device industries.
Objective
To evaluate the nature of industry relationships among cardiologists using the Open Payments database.
Methods
The authors used the Centers for Medicare & Medicaid Services Open Payments data for calendar year 2015 to evaluate the financial relationship between cardiologists and medical industries (manufacturers of medications, devices, biologics, and medical supplies). The database used in this specific investigation included general payments reported for 2015. Payments were broken down by totals, type, company, and range.
Results
In the 2015 calendar year, 81,977 payments were made to 12,078 cardiologists, amounting to $13,906,167.43. The minimum payment made to a cardiologist was $1.16 and the maximum, $2,805,825. The most frequent category was $11 to $50, with 53,722 payments made (65.5%), followed by less than $10, with 12,307 payments made (15.0%).
Conclusion
Payments to cardiologists were highly variable. Additional studies regarding the effects of these payments may be warranted.
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Cooper CM, Checketts JX, Brame L, Gray H, Downs JB, Vassar M. An analysis of the literature addressing tonsillectomy knowledge gaps. Int J Pediatr Otorhinolaryngol 2018; 115:89-93. [PMID: 30368401 DOI: 10.1016/j.ijporl.2018.09.027] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 09/24/2018] [Accepted: 09/25/2018] [Indexed: 10/28/2022]
Abstract
IMPORTANCE The ability of clinical practice guidelines to improve patient outcomes depends on the quality of evidence that they are built upon. Research into tonsillectomy in children is lacking, and the gaps in evidence were identified by guideline authors. OBJECTIVE The objective of this study is to evaluate the extent that new research is addressing the gaps identified in the AAO-HNS Tonsillectomy in Children Guideline. DESIGN For each recommendation in the AAO-HNS guideline Tonsillectomy In Children, we created PICO (Participants, Intervention, Comparator, Outcome) questions and search strings. PubMed was searched to locate studies undertaken after the final literature search performed by the AAO-HNS work group. These studies were then extracted and analyzed. SETTING This study is relevant to all invested in focusing otolaryngological research on questions which currently lack strong evidence. PARTICIPANTS Trials in tonsillectomy that started after the development of the AAO-HNS clinical practice guidelines. MAIN OUTCOME MEASURES The main outcome measures of this study is the extent to which tonsillectomy research is addressing the evidence gaps listed in the clinical practice guideline. RESULTS Of the 2519 studies included in our sample, 276 (11%) were relevant to the 18 recommendations made within the Tonsillectomy in Pediatric Patients clinical practice guideline. All but one of the recommendations was met by at least one study. CONCLUSIONS and Relevance: Our findings indicate that knowledge gaps within the guideline at publication may have since been addressed and a guideline update may thus be warranted. LEVEL OF EVIDENCE NA.
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Affiliation(s)
- Craig M Cooper
- Oklahoma State University Center for Health Sciences, United States.
| | - Jake X Checketts
- Oklahoma State University Center for Health Sciences, United States
| | - Lacy Brame
- Oklahoma State University Center for Health Sciences, United States
| | - Harrison Gray
- Oklahoma State University Center for Health Sciences, United States
| | - Jaye Bea Downs
- Oklahoma State University Medical Center - Department of Otolaryngology, United States
| | - Matt Vassar
- Oklahoma State University Center for Health Sciences, United States
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Checketts JX, Scott J, Gordon J, Jones J, Horn J, Farabough M, Whitener J, Boose M, Vassar M. An Evaluation of the Rotator Cuff Repair Research Pipeline. Orthop J Sports Med 2018; 6:2325967118805731. [PMID: 30480012 PMCID: PMC6243427 DOI: 10.1177/2325967118805731] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND We conducted a study of recommendations from the American Academy of Orthopaedic Surgeons (AAOS) guideline, "Optimizing the Management of Rotator Cuff Problems." Using these recommendations, we conducted searches of clinical trial registries and bibliographic databases to note the extent to which new research has been undertaken to address areas of deficiency. HYPOTHESIS Newly conducted research regarding rotator cuff repair and injury is available that will fill knowledge gaps identified by the AAOS guideline. STUDY DESIGN Cross-sectional study. METHODS For each recommendation in the AAOS guideline, we created PICO (participants, intervention, comparator, outcome) questions and search strings. Searches were conducted of ClinicalTrials.gov, the World Health Organization's International Clinical Trials Registry Platform, MEDLINE via PubMed, and EMBASE to locate studies undertaken after the final literature search performed by the AAOS work group. RESULTS We located 210 newly registered trials and 448 published studies that are relevant to the recommendations made in the rotator cuff guideline. The majority of the recommendations have been addressed by relevant registered trials or published studies. Of the 448 published studies, 185 directly addressed the guideline recommendations. Additionally, 71% of the 185 published studies directly addressing the recommendations were randomized trials or systematic reviews/meta-analyses. The most important finding of our study was that the recommendations in the AAOS rotator cuff guideline have been adequately addressed. CONCLUSION Orthopaedic researchers have adequately addressed knowledge gaps regarding rotator cuff repair treatment and management options. As such, the AAOS may consider a guideline update to ensure that recommendations reflect current findings in orthopaedic literature.
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Affiliation(s)
- Jake X. Checketts
- Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Jared Scott
- Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Josh Gordon
- Department of Anesthesiology, University of Oklahoma, Norman, Oklahoma, USA
| | - Jaclyn Jones
- Department of Orthopaedic Surgery, Oklahoma State University Medical Center, Tulsa, Oklahoma, USA
| | - Jarryd Horn
- Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Michelle Farabough
- Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Jake Whitener
- Department of Orthopaedic Surgery, Oklahoma State University Medical Center, Tulsa, Oklahoma, USA
| | - Marshall Boose
- Department of Orthopaedic Surgery, Oklahoma State University Medical Center, Tulsa, Oklahoma, USA
| | - Matt Vassar
- Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
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Checketts JX, Evans MB, Athale AH, Jawhar OM, Wright MR, Bryant K, Vassar M. Compliance on Mandatory Data Reporting in Registered Obstetrics Trials. Am J Perinatol 2018; 35:1192-1196. [PMID: 29695018 DOI: 10.1055/s-0038-1642620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND The Food and Drug Administration's (FDA's) Amendments Act established a legal mandate requiring registration of certain drug, device, and biologics trials in ClinicalTrials.gov prior to patient enrollment. One provision of the act requires investigators to report trial results in ClinicalTrials.gov within 1 year of completion. Preliminary evidence suggests that overall compliance rates are inadequate, and rates specific to obstetrics have not been investigated. OBJECTIVE The purpose of this study was to examine the rate of compliance for mandatory reporting of results from obstetrics trials to ClinicalTrials.gov and to determine whether compliance rates were associated with funding type. STUDY DESIGN We performed a registry-based study of clinical trials pertaining to obstetrics. ClinicalTrials.gov was cross-referenced with Drugs@FDA to determine which trials required mandatory reporting. We used obstetrics trials registered on ClinicalTrials.gov with at least 1 US site. Phase 0, Phase 1, and trials not reporting a phase were excluded. Furthermore, only trials of interventions approved by the FDA were retained. RESULTS Our search returned 973 trials, of which 325 (33.4%) were screened for eligibility. Of the 325 completed trials, 74 (22.8% or 7.6% of the total) met all inclusion criteria and were evaluated for compliance. Thirty-seven of these trials (50%) did not list results, whereas the remaining 37 trials (50%) contained results on ClinicalTrials.gov. Trials funded by the National Institutes of Health (87.5%; ⅞) and industry (80%; 12/15) had higher rates of compliance than trials funded by other (43.9%; 18/41) or unspecified (0%; 0/10) sources. CONCLUSION Half of all applicable obstetrics trials did not report results. Furthermore, rates of compliance appeared to vary by funding source, with trials funded by the National Institutes of Health or industry appearing to have a higher rate of compliance to mandatory data reporting. Greater awareness of federal regulations is needed, and changes should be implemented to increase reporting.
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Affiliation(s)
- Jake X Checketts
- Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma
| | - M Blake Evans
- Department of Obstetrics and Gynecology, Oklahoma State University Medical Center, Tulsa, Oklahoma
| | - Abha H Athale
- Arizona College of Osteopathic Medicine, Glendale, Arizona
| | - Omar M Jawhar
- Arizona College of Osteopathic Medicine, Glendale, Arizona
| | - Micah R Wright
- Department of Obstetrics and Gynecology, Oklahoma State University Medical Center, Tulsa, Oklahoma
| | - Kristine Bryant
- Department of Obstetrics and Gynecology, Oklahoma State University Medical Center, Tulsa, Oklahoma
| | - Matt Vassar
- Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma
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Golmoradi K, Checketts JX, Moore G, Vassar M, Buck TR. Is the Right Research Being Done to Guide the Development of the American Academy of Child and Adolescent Psychiatry's Practice Parameters? J Am Acad Child Adolesc Psychiatry 2018; 57:516-518. [PMID: 29960698 DOI: 10.1016/j.jaac.2018.03.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 01/08/2018] [Revised: 02/13/2018] [Accepted: 05/04/2018] [Indexed: 11/18/2022]
Abstract
The American Academy of Child and Adolescent Psychiatry (AACAP) developed Practice Parameters (PPs) to provide recommendations regarding the assessment and treatment of children and adolescents with mental health disorders. Each recommendation comes with a rating, based on the level of evidence. In descending order, recommendations are rated as a clinical standard (CS), clinical guideline, or clinical option (CO), as well as recommendations that are "not endorsed" due to ineffectiveness or contraindication. According to the PPs, a recommendation is rated as a CS if it is supported by "rigorous empirical evidence and/or overwhelming clinical consensus," whereas, the lower quality recommendations, rated as COs, are founded on "emerging empirical evidence (e.g. uncontrolled trials or case series/reports) or clinical opinion, but lack strong evidence and/or strong clinical consensus." Based on the current definition, clinicians may be perpetuating practices that are based on as little as expert opinion. We are aware that AACAP is in the process of transitioning from PPs to Clinical Practice Guidelines (CPGs), which will embody a systematic approach to reconcile recommendations with national guidelines. In accordance with these higher standards, we believe that our evaluation of the research gaps will elucidate the need to encourage resource allocation in deficient areas.
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Affiliation(s)
- Kia Golmoradi
- Oklahoma State University Center for Health Sciences
| | | | | | - Matt Vassar
- Oklahoma State University Center for Health Sciences
| | - Tara R Buck
- University of Oklahoma School of Community Medicine
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Checketts JX, Sims MT, Detweiler B, Middlemist K, Jones J, Vassar M. An Evaluation of Reporting Guidelines and Clinical Trial Registry Requirements Among Orthopaedic Surgery Journals. J Bone Joint Surg Am 2018; 100:e15. [PMID: 29406351 DOI: 10.2106/jbjs.17.00529] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The responsibility for ensuring that studies are adequately reported is primarily that of those conducting the study; however, journal policies may influence how thoroughly authors choose to report their research. The use of reporting guidelines and prospective trial registration are promising avenues for ensuring that published studies adhere to the highest methodological standards. The purpose of this study is to evaluate orthopaedic surgery journal policies regarding reporting guidelines and trial registration, and to evaluate the effects that these policies have on adherence to reporting. METHODS We conducted a cross-sectional survey of journal policies and "Instructions for Authors" to determine the journals' policies and guidance regarding use of reporting guidelines and study registration. We also examined whether trials published in journals referencing CONSORT (Consolidated Standards of Reporting Trials) had higher rates of compliance with publishing a CONSORT flow diagram and whether journals with trial registration policies were more likely to contain registered trials than journals without these requirements. RESULTS Of the 21 orthopaedic surgery journals, 6 (29%) did not mention a single guideline, and clinical trial registration was required by 11 (52%) orthopaedic surgery journals and recommended by 2 (10%). Of the 21 general medical journals, 3 (14%) did not mention a single guideline, and trial registration was required by 13 (62%) general medical journals and recommended by 5 (24%) others. Furthermore, journals that referenced CONSORT were more likely to publish trials with a CONSORT flow diagram. Journals with trial registration policies were more likely to publish registered trials. CONCLUSIONS Reporting guidelines and trial registration are suboptimally required or recommended by orthopaedic surgery journals. These 2 mechanisms may improve methodology and quality, and should be considered for adoption by journal editors in orthopaedic surgery. CLINICAL RELEVANCE Because orthopaedic surgeons rely on high-quality research to direct patient care, measures must be taken to ensure that published research is of the highest quality. The use of reporting guidelines and prospective clinical trial registration may improve the quality of orthopaedic research, thereby improving patient care.
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Affiliation(s)
- Jake X Checketts
- Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma
| | - Mathew T Sims
- Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma
| | - Byron Detweiler
- Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma
| | - Kevin Middlemist
- Department of Orthopaedics, Oklahoma State University Medical Center, Tulsa, Oklahoma
| | - Jaclyn Jones
- Department of Orthopaedics, Oklahoma State University Medical Center, Tulsa, Oklahoma
| | - Matt Vassar
- Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma
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Checketts JX, Simpson A, Scott J, Brame L, Duckett L, Vassar M. An analysis of the breast reduction mammaplasty research pipeline. J Plast Reconstr Aesthet Surg 2018; 71:933-935. [PMID: 29398606 DOI: 10.1016/j.bjps.2018.01.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 01/05/2018] [Accepted: 01/21/2018] [Indexed: 10/18/2022]
Affiliation(s)
- Jake X Checketts
- Oklahoma State University Center for Health Sciences, Oklahoma, United States
| | - Alaina Simpson
- Oklahoma State University Medical Center Department of Surgery, Oklahoma, United States
| | - Jared Scott
- Oklahoma State University Center for Health Sciences, Oklahoma, United States
| | - Lacy Brame
- Oklahoma State University Center for Health Sciences, Oklahoma, United States
| | - Laurie Duckett
- Oklahoma State University Medical Center Department of Surgery, Oklahoma, United States
| | - Matt Vassar
- Oklahoma State University Center for Health Sciences, Oklahoma, United States.
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Checketts JX, Cook C, Vassar M. An Evaluation of Industry Relationships Among Contributors to AAOS Clinical Practice Guidelines and Appropriate Use Criteria. J Bone Joint Surg Am 2018; 100:e10. [PMID: 29342070 DOI: 10.2106/jbjs.17.00184] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND A long-standing relationship between orthopaedic surgeons and industry has made financial conflicts of interest a concerning issue. Research supports that financial conflicts of interest can influence both medical research and clinical practice. Financial conflicts of interest may also influence clinical practice guideline recommendations and their corresponding appropriate use criteria. Because of the influential nature of these guidelines, it is imperative that care be taken to minimize bias during guideline development. METHODS We retrieved clinical practice guidelines and their corresponding appropriate use criteria from the American Academy of Orthopaedic Surgery that were published or revised between 2013 and 2016. We extracted industry payments received by physicians using the Centers for Medicare & Medicaid Services Open Payments database. We then evaluated the value and types of these payments. We also used these data to determine whether disclosure statements were accurate and whether guideline development was in adherence with the Institute of Medicine's (IOM's) standards. RESULTS Of the 106 physicians that were evaluated, 85 (80%) received at least 1 industry payment, 56 (53%) accepted >$1,000, and 35 (33%) accepted >$10,000. Financial payments amounted to a mean of $93,512 per physician. Total reimbursement for the 85 clinical practice guideline and appropriate use criteria contributors was $9,912,309. We found that disclosure statements disagreed with the Open Payments data and that the IOM standards were not completely enforced. CONCLUSIONS Clinical practice guideline and appropriate use criteria contributors received substantial payments from industry, many disclosure statements were inaccurate, and the IOM standards were not completely met. CLINICAL RELEVANCE Clinical practice guidelines and appropriate use criteria are critical for practicing evidence-based medicine. If financial conflicts of interest are present during their development, it is possible that patient care may be compromised.
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Affiliation(s)
- Jake X Checketts
- Center for Health Sciences, Oklahoma State University, Tulsa, Oklahoma
| | - Courtney Cook
- Center for Health Sciences, Oklahoma State University, Tulsa, Oklahoma
| | - Matt Vassar
- Center for Health Sciences, Oklahoma State University, Tulsa, Oklahoma
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Abstract
Importance It is well documented that financial conflicts of interest influence medical research and clinical practice. Prior to the Open Payments provisions of the Affordable Care Act, financial ties became apparent only through self-disclosure. The nature of financial interests has not been studied among physicians who develop dermatology clinical practice guidelines. Objective To evaluate payments received by physicians who author dermatology clinical practice guidelines, compare disclosure statements for accuracy, determine whether pharmaceutical companies from which the authors received payments manufactured products related to the guidelines, and examine the extent to which the American Academy of Dermatology enforced their Administrative Regulations for guideline development. Design, Setting, and Participants Three American Academy of Dermatology guidelines published from 2013 to 2016 were retrieved. Double data extraction was used to record financial payments received by 49 guideline authors using the Open Payments database. Payments received by the authors from the date of the initial literature search to the date of publication were used to evaluate disclosure statement accuracy, detail the companies providing payments, and evaluate Administrative Regulations enforcement. This study is applicable to clinical practice guideline panels drafting recommendations, physicians using clinical practice guidelines to inform patient care, and those establishing policies for guideline development. Main Outcomes and Measures Our main outcomes are the monetary values and types of payments received by physicians who author dermatology guidelines and the accuracy of disclosure statements. Data were collected from the Open Payments database and analyzed descriptively. Results Of the 49 authors evaluated, 40 received at least 1 reported industry payment, 31 accepted more than $1000, 25 accepted more than $10 000, and 18 accepted more than $50 000. Financial payments amounted to a mean of $157 177 per author. The total reimbursement among the 49 authors from 2013 to 2015 was $7 701 681. Of the 40 authors receiving payments, 22 did not accurately disclose industry relationships. Authors received payments from companies with products directly related to the guideline topic. Violations to the Administrative Regulations were found. Conclusions and Relevance Dermatology clinical practice guideline authors received sizable industry payments and did not completely disclose these payments. The American Academy of Dermatology policies may benefit from stricter enforcement or the adoption of new standards.
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Affiliation(s)
| | | | - Matt Vassar
- Center for Health Sciences, Oklahoma State University, Tulsa
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