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Park JW, Yoo JH, Lee YK, Park JS, Won YY. Treatment of Osteoporosis after Hip Fracture: Survey of the Korean Hip Society. Hip Pelvis 2024; 36:62-69. [PMID: 38420739 DOI: 10.5371/hp.2024.36.1.62] [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: 05/17/2023] [Revised: 07/10/2023] [Accepted: 07/12/2023] [Indexed: 03/02/2024] Open
Abstract
Purpose To assess current practice in the treatment of osteoporosis in patients who underwent treatment for hip fracture in South Korea. Materials and Methods A survey of 97 members of the Korean Hip Society, orthopedic hip surgeons who administer treatment for hip fractures in South Korea, was conducted. The survey was conducted for assessment of demographic data and perceptions regarding the management of osteoporosis in patients who have undergone treatment for hip fracture. Analysis of the data was performed using descriptive statistical methods. Results The majority of participants were between the age of 41 and 50 years, and 74% were practicing in tertiary hospitals. Testing for serum vitamin D levels (82%) was the most commonly performed laboratory test. Calcium and vitamin D were prescribed for more than 80% of patients by 47% and 52% of participants, respectively. Denosumab was the most commonly used first-line treatment option for osteoporosis in hip fracture patients. Bisphosphonate was most often perceived as the cause of atypical femoral fractures, and the most appropriate time for reoperation was postoperative 12 months. Teriparatide was most preferred after cessation of bisphosphonate and only prescribing calcium and vitamin D was most common in high-risk patients for prevention of atypical femoral fracture. Conclusion The results of this study that surveyed orthopedic hip surgeons showed that most participants followed the current strategy for management of osteoporosis. Because the end result of osteoporosis is a bone fracture, active involvement of orthopedic surgeons is important in treating this condition.
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Affiliation(s)
- Jung-Wee Park
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Je-Hyun Yoo
- Department of Orthopedic Surgery, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Young-Kyun Lee
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jong-Seok Park
- Department of Orthopedic Surgery, Soonchunhyang University Hospital Cheonan, Cheonan, Korea
| | - Ye-Yeon Won
- Department of Orthopedic Surgery, Ajou University College of Medicine, Suwon, Korea
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Tsuchiya A, Wada K, Morikane K, Yoshikawa T, Hosomi Y, Dhungel B, Kunishima H. Characteristics of needlestick and sharps injuries of the hands in the operating room among orthopedic surgeons in Japan. Ind Health 2023; 61:151-157. [PMID: 35249893 PMCID: PMC10079498 DOI: 10.2486/indhealth.2021-0194] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 02/15/2022] [Indexed: 06/14/2023]
Abstract
Among the reports on needlestick and sharps injuries (NSIs), many are orthopedic-related due to the frequent use of sharp devices such as pins and wires. This study aimed to identify high-risk instruments, the most common injury sites for each instrument, and the circumstances of NSIs of the hand during orthopedic surgeries in Japan. Incidents of exposure to blood or bodily fluids among physicians during orthopedic surgeries reported to the Japan-EPINet between 2000 and 2015 were included in this study. The four most common devices were identified and the associations among years of experience, equipment users, and injured sites were analyzed. We identified 666 cases of NSIs affecting orthopedic surgeons in the operating room. The instrument most frequently responsible for NSIs was suture needles, which were involved in 265 cases (39.7%). The second most common instrument was pins/wires, which was involved in 111 cases (16.6%). NSIs of the hands of orthopedic surgeons were frequently caused by suture needles used in all surgeries, but relatively often caused by orthopedic devices. Orthopedic surgeons must be aware that they are at risk of NSIs and must take appropriate measures and always be cautious when performing surgery, regardless of their years of experience.
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Affiliation(s)
- Akihiro Tsuchiya
- Department of Social Medical Sciences, Graduate School of Medicine, International University of Health and Welfare, Japan
- The Research Group of Occupational Infection Control and Prevention in Japan
| | - Koji Wada
- Department of Social Medical Sciences, Graduate School of Medicine, International University of Health and Welfare, Japan
- The Research Group of Occupational Infection Control and Prevention in Japan
| | - Keita Morikane
- Division of Clinical Laboratory and Infection Control, Yamagata University Hospital, Japan
- The Research Group of Occupational Infection Control and Prevention in Japan
| | - Toru Yoshikawa
- National Institute of Occupational Safety and Health, Japan
- The Research Group of Occupational Infection Control and Prevention in Japan
| | - Yumiko Hosomi
- International Safety Center, Inc., USA
- The Research Group of Occupational Infection Control and Prevention in Japan
| | - Bibha Dhungel
- Graduate School of Public Health, St. Luke's International University, Japan
- Department of Health Policy, National Center for Child Health and Development, Japan
| | - Hiroyuki Kunishima
- Department of Infectious Diseases. St. Marianna University School of Medicine, Japan
- The Research Group of Occupational Infection Control and Prevention in Japan
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Sarfani S, Rees A, Vickery J, Kuhn JE, Galloway MB, Domenico H, Pichert JW, Cooper WO. Patient Complaints in Orthopedic Surgery: An Analysis Utilizing a Large National Database. Orthop Clin North Am 2022; 53:491-7. [PMID: 36208891 DOI: 10.1016/j.ocl.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Unsolicited patient complaints (UPCs) about surgeons correlate with surgical complications and malpractice claims. Analysis of UPCs in orthopedics is limited. METHODS Patient complaint reports recorded at 36 medical centers between January 1, 2015 and December 31, 2018 were coded using a previously validated coding algorithm Patient Advocacy Reporting System. RESULTS A total of 33,174 physicians had 4 consecutive years of data across the 36 participating medical centers and met other inclusion criteria. CONCLUSIONS Orthopedists with high numbers of UPCs may benefit from being made aware of their elevated risk status in ways that invite reflection on underlying causes.
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Mian HM, Lyons JG, Perrin J, Froehle AW, Krishnamurthy AB. A review of current practices in periprosthetic joint infection debridement and revision arthroplasty. Arthroplasty 2022; 4:31. [PMID: 36045436 PMCID: PMC9434893 DOI: 10.1186/s42836-022-00136-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 06/09/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Periprosthetic joint infection remains a significant challenge for arthroplasty surgeons globally. Over the last few decades, there has been much advancement in terms of treatment and diagnosis, however, the fight rages on. As management of periprosthetic joint infections continues to evolve, it is critical to reflect back on current debridement practices to establish common ground as well as identify areas for future research and improvement. BODY: In order to understand the debridement techniques of periprosthetic joint infections, one must also understand how to diagnose a periprosthetic joint infection. Multiple definitions have been elucidated over the years with no single consensus established but rather sets of criteria. Once a diagnosis has been established the decision of debridement method becomes whether to proceed with single vs two-stage revision based on the probability of infection as well as individual patient factors. After much study, two-stage revision has emerged as the gold standard in the management of periprosthetic infections but single-stage remains prominent with further and further research. CONCLUSION Despite decades of data, there is no single treatment algorithm for periprosthetic joint infections and subsequent debridement technique. Our review touches on the goals of debridement while providing a perspective as to diagnosis and the particulars of how intraoperative factors such as intraarticular irrigation can play pivotal roles in infection eradication. By providing a perspective on current debridement practices, we hope to encourage future study and debate on how to address periprosthetic joint infections best.
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Affiliation(s)
- Humza M Mian
- Department of Orthopaedic Surgery, Wright State University Boonshoft School of Medicine, 30 E. Apple St. Suite #2200, Dayton, OH, 45409, USA.
| | - Joseph G Lyons
- Department of Orthopaedic Surgery, Wright State University Boonshoft School of Medicine, 30 E. Apple St. Suite #2200, Dayton, OH, 45409, USA
| | - Joshua Perrin
- Wright State University Boonshoft School of Medicine, Wright State Physicians Bldg, 725 University Blvd., Dayton, OH, 45435, USA
| | - Andrew W Froehle
- Department of Orthopaedic Surgery, Wright State University Boonshoft School of Medicine, 30 E. Apple St. Suite #2200, Dayton, OH, 45409, USA
- School of Nursing, Kinesiology and Health, Wright State University, 3640 Colonel Glenn Hwy., Dayton, OH, 45435, USA
| | - Anil B Krishnamurthy
- Department of Orthopaedic Surgery, Wright State University Boonshoft School of Medicine, 30 E. Apple St. Suite #2200, Dayton, OH, 45409, USA
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Harris H, Poole W, Rogers B, Ricketts D. Release of individual surgeon data to the public: patients' and surgeons' views. Ann R Coll Surg Engl 2022; 104:106-112. [PMID: 34898292 PMCID: PMC10335083 DOI: 10.1308/rcsann.2021.0106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Limited surgeon-specific outcomes data are currently released to the public. Existing schemes generally result from the recommendations of public enquiries, addressing breaches to patient safety and malpractice. We found limited evidence in the literature about patients' or orthopaedic surgeons' wishes regarding the release of such data to the public. METHODS We surveyed 80 joint replacement patients and 41 orthopaedic surgeons regarding their wishes concerning collection and release of individual surgeon data to the public. RESULTS Of 80 patients, 30% (24/80) were aware of data on the NHS-My Choices website, 16% (13/80) had reviewed data prior to operation and 95% (76/80) wanted data concerning surgeons' experience, length of stay and complications including revisions. Patients expected more current monitoring of data than occurs. Of 41 surgeons, 20% (8/41) thought national joint registry (NJR) derived data accurately reflected their NHS work. Surgeons did not think this data improved patient outcomes (34%, 14/41), and that it reduced innovation (61%, 25/41) and training (75%, 31/41) and increased risk of adverse behaviour (61%, 25/41). Surgeons wanted a minimal data set accurately presented and risk adjusted. CONCLUSION In the future, it is likely that more individual surgeon data will be released to the public. There needs to be an agreed, accurate minimum dataset collected, reviewed in local clinical governance meetings and published with explanatory notes regarding the interfering variables and what conclusions can be drawn regarding the ability of the surgeon. This process needs to be overseen by an independent body trusted by the public.
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Affiliation(s)
| | - W Poole
- University Hospitals Sussex, UK
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Wong CR, Sacevich N, McRae MC, Heywood J, Upadhye S. Sensory neuropraxia of the median nerve in a perilunate injury: a review of a near miss. CAN J EMERG MED 2021; 23:709-711. [PMID: 33993454 DOI: 10.1007/s43678-021-00144-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 05/05/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Chloe R Wong
- McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada.
| | - Nathan Sacevich
- McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
| | - Matthew C McRae
- McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
| | - James Heywood
- McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
| | - Suneel Upadhye
- McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
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Emara K, Emara AK, Farhan M, Mahmoud S. What orthopedic surgeons need to know about Covid-19 pandemic. J Orthop 2020; 21:275-277. [PMID: 32501382 PMCID: PMC7237925 DOI: 10.1016/j.jor.2020.05.016] [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] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/15/2020] [Accepted: 05/16/2020] [Indexed: 01/08/2023] Open
Abstract
The ongoing outbreak of COVID-19, also known as SARS-CoV-2 and coronavirus disease 2019, is considered a major public concern that propagates steadily by the increased number of the infected cases and the mortality rate. In this article, we provide a brief review for Orthopedic surgeons as regard COVID-19 virus microbiology, epidemiology, clinical picture, and diagnosis. Moreover, what measures should be taken amid this pandemic to assess its control, maintain the urgent duties, and protect health care workers (HCW) are also discussed.
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Affiliation(s)
- Khaled Emara
- Orthopaedic Surgery, Ain Shams University Hospitals, Egypt
| | - Ahmed K. Emara
- Department of Orthopedic Surgery, Cleveland Clinic, 9500 Euclid Avenue, Mailcode A41, Cleveland, OH, 44195, USA
| | - Mona Farhan
- Orthopaedic Surgery, Ain Shams University Hospitals, Egypt
| | - Shady Mahmoud
- Orthopaedic Surgery, Ain Shams University Hospitals, Egypt
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Zahid M, Ali A, Baloch NJ, Noordin S. Effects of coronavirus (COVID-19) pandemic on orthopedic residency program in the seventh largest city of the world: Recommendations from a resource-constrained setting. Ann Med Surg (Lond) 2020; 56:142-144. [PMID: 32632350 PMCID: PMC7315970 DOI: 10.1016/j.amsu.2020.06.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 06/16/2020] [Accepted: 06/16/2020] [Indexed: 11/29/2022] Open
Abstract
The coronavirus (COVID-19) pandemic has hit the entire world hard. Since its inception from Wuhan China the whole world is affected now. Health care facilities and workers are overwhelmed and the situation is changing on daily basis. With the changes in the dynamics of the hospitals, residency and fellowships training programs have also suffered undoubtedly. Due to decreased elective cases and outpatient clinics surgical training gets compromised, however on the other side this physical distancing and isolation have proven to be effective measures in controlling the disease. In this article we share our experience of effect of COVID-19 pandemic on our orthopedic residency program and how we coped along with it. We also discussed some way forwards in the article.
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Affiliation(s)
- Marij Zahid
- Orthopedic Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Arif Ali
- Orthopedic Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | | | - Shahryar Noordin
- Orthopedic Surgery, Aga Khan University Hospital, Karachi, Pakistan
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Björk J, Juth N, Lynøe N. "Right to recommend, wrong to require"- an empirical and philosophical study of the views among physicians and the general public on smoking cessation as a condition for surgery. BMC Med Ethics 2018; 19:2. [PMID: 29310657 PMCID: PMC5759185 DOI: 10.1186/s12910-017-0237-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 12/01/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In many countries, there are health care initiatives to make smokers give up smoking in the peri-operative setting. There is empirical evidence that this may improve some, but not all, operative outcomes. However, it may be feared that some support for such policies stems from ethically questionable opinions, such as paternalism or anti-smoker sentiments. This study aimed at investigating the support for a policy of smoking cessation prior to surgery among Swedish physicians and members of the general public, as well as the reasons provided for this. METHODS A random sample of general practitioners and orthopaedic surgeons (n = 795) as well as members of the general public (n = 485) received a mail questionnaire. It contained a vignette case with a smoking 57-year old male farmer with hip osteoarthritis. The patient had been recommended hip replacement therapy, but told that in order to qualify for surgery he needed to give up smoking four weeks prior to and after surgery. The respondents were asked whether making such qualifying demands is acceptable, and asked to rate their agreement with pre-set arguments for and against this policy. RESULTS Response rates were 58.2% among physicians and 53.8% among the general public. Of these, 83.9% and 86.6%, respectively, agreed that surgery should be made conditional upon smoking cessation. Reference to the peri-operative risks associated with smoking was the most common argument given. However, there was also strong support for the argument that such a policy is mandated in order to achieve long term health gains. CONCLUSIONS There is strong support for a policy of smoking cessation prior to surgery in Sweden. This support is based on considerations of peri-operative risks as well as the general long term risks of smoking. This study indicates that paternalistic attitudes may inform some of the support for peri-operative smoking cessation policies and that at least some respondents seem to favour a "recommendation strategy" vis-à-vis smoking cessation prior to surgery rather than a "requirement strategy". The normative reasons speak in favour of the "recommendation strategy".
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Affiliation(s)
- Joar Björk
- Stockholm Centre for Healthcare Ethics (CHE), LIME, Karolinska Institutet, Tomtebodavägen 18 A, 171 77, Stockholm, Sweden. .,Department of Research and Development, Region Kronoberg, Sigfridsvägen 5, 352 57, Växjö, Sweden.
| | - Niklas Juth
- Stockholm Centre for Healthcare Ethics (CHE), LIME, Karolinska Institutet, Tomtebodavägen 18 A, 171 77, Stockholm, Sweden
| | - Niels Lynøe
- Stockholm Centre for Healthcare Ethics (CHE), LIME, Karolinska Institutet, Tomtebodavägen 18 A, 171 77, Stockholm, Sweden
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10
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Anderson-Wurf J, McGirr J, Seal A, Harding C. Orthopedic surgeons' attitudes to osteoporosis investigation and management after minimal trauma fracture (MTF). Arch Osteoporos 2017; 12:2. [PMID: 28004296 DOI: 10.1007/s11657-016-0296-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 07/25/2016] [Accepted: 12/05/2016] [Indexed: 02/03/2023]
Abstract
UNLABELLED A study of orthopedic surgeons in rural and regional Southeast Australia to determine attitudes to investigation and management of osteoporosis found they believe follow-up in regard to osteoporosis after MTF is important; responsibility for follow-up diagnosis and management lies with primary health care and current communication systems are poor. PURPOSE/INTRODUCTION The investigation and treatment of osteoporosis after minimal trauma fracture (MTF) is regarded as sub-optimal. There is strong evidence of the benefit of identifying and treating osteoporosis after MTF, and there has been discussion of the possible role that orthopedic surgeons might play in the management of osteoporosis after MTF. The study surveyed orthopedic surgeons in rural and regional Southeast Australia to determine their attitudes to investigation and management of osteoporosis, the role health professionals should play, and the communication and co-ordination of follow-up care. METHODS A survey was developed and piloted prior to being posted to 69 orthopedic surgeons asking for their opinions about the general management of osteoporosis, and the roles and responsibilities of health professionals in dealing with osteoporosis following an MTF. RESULTS Responses were received from 42 participants (60.8%) with the majority of respondents agreeing that it is important to treat osteoporosis following MTF. Less than 15% of respondents felt that it was their responsibility to initiate discussion or treatment or investigation after MTF. No respondent felt that the coordination of osteoporosis care was good and 45% stated it was poor. Communication after discharge is mostly left to the hospital (30%), while 20% stated they did not follow up at all. CONCLUSIONS This study shows that many rural orthopedic surgeons believe that follow-up in regard to osteoporosis after MTF is important, that responsibility for follow-up diagnosis and management of osteoporosis lies with primary health care and the current communication systems are poor.
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Affiliation(s)
- Jane Anderson-Wurf
- School of Medicine Sydney, Rural Clinical School, The University of Notre Dame Australia, PO Box 5050, Wagga Wagga, NSW, 2650, Australia.
| | - Joe McGirr
- School of Medicine Sydney, Rural Clinical School, The University of Notre Dame Australia, PO Box 5050, Wagga Wagga, NSW, 2650, Australia
| | - Alexa Seal
- School of Medicine Sydney, Rural Clinical School, The University of Notre Dame Australia, PO Box 5050, Wagga Wagga, NSW, 2650, Australia
| | - Catherine Harding
- School of Medicine Sydney, Rural Clinical School, The University of Notre Dame Australia, PO Box 5050, Wagga Wagga, NSW, 2650, Australia
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Schneider PS, Wall M, Brown JP, Cheung AM, Harvey EJ, Morin SN. Atypical femur fractures: a survey of current practices in orthopedic surgery. Osteoporos Int 2017; 28:3271-3276. [PMID: 28770273 DOI: 10.1007/s00198-017-4155-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 07/07/2017] [Indexed: 11/25/2022]
Abstract
UNLABELLED The results of a self-administered online survey demonstrate that orthopedic surgeons' management practices for AFF are variable. These data will inform the development of clinical practice guidelines. INTRODUCTION We aimed to determine current AFF treatment practices of orthopedic surgeons to inform clinical practice guideline development. METHODS A self-administered online survey was developed and sequentially posted on the Orthopaedic Trauma Association (OTA) website from July to August 2015 and the Canadian Orthopaedic Association (COA) website from December 2015 to January 2016. Level of confidence in diagnosis and treatment as well as treatment preferences between respondents who self-identified as trauma surgeons vs. non-trauma surgeons were compared. RESULTS A total of 172 completed surveys were obtained (OTA, N = 100, 58%; COA, N = 72, 8%). Seventy-eight percent of respondents had treated ≥1 AFF in the previous 6 months. Seventy-six percent reported feeling extremely or very confident in diagnosing AFF (trauma 84% vs. non-trauma surgeons 70%, p = 0.04), and 63% reported feeling extremely or very confident in treating AFF (trauma 82%, non-trauma surgeons 50%, p < 0.01). Preferred management for complete and symptomatic incomplete AFFs was surgical fixation with a cephalomedullary nail (CMN) by 88 and 79%, respectively, while close follow-up was preferred for asymptomatic incomplete AFFs in 72% of respondents. Trauma surgeons used the CMN more frequently than non-trauma surgeons (90 vs. 76% p = 0.03). In patients with bilateral AFFs, with one side surgically treated, 56% were extremely likely to surgically treat the contralateral side, if symptomatic. Most felt guidelines (81%) and educational resources (73%) would be valuable. CONCLUSIONS Current orthopedic treatment practices for AFFs are variable. The results of this survey will inform the development of practice guidelines and educational resources.
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Affiliation(s)
- P S Schneider
- Department of Surgery, Division of Orthopaedic Trauma, Foothills Medical Centre, University of Calgary, McCaig Tower, 3134 Hospital, Drive NW, Calgary, AB, T2N 5A1, Canada.
| | - M Wall
- Research Institute of the McGill University Health Center, Montreal, Canada
| | - J P Brown
- Department of Medicine, Laval University, Quebec City, Canada
| | - A M Cheung
- Department of Medicine, University of Toronto, Toronto, Canada
| | - E J Harvey
- Research Institute of the McGill University Health Center, Montreal, Canada
- Department of Surgery, McGill University, Montreal, Canada
| | - S N Morin
- Research Institute of the McGill University Health Center, Montreal, Canada
- Department of Medicine, McGill University, Montreal, Canada
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Bailey J, Hawker GA, Wood R, Cappelleri JC, Higgins V, Joyce N, Hsu MA. Impact of physician specialty on classification of physician-perceived patient severity for patients with osteoarthritis. Osteoarthritis Cartilage 2014; 22:647-51. [PMID: 24631922 DOI: 10.1016/j.joca.2014.03.001] [Citation(s) in RCA: 3] [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: 11/19/2013] [Revised: 01/23/2014] [Accepted: 03/04/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND Physicians often classify patients' osteoarthritis (OA) severity subjectively. As treatment decisions are influenced by severity classifications, it is important to understand the factors that influence physicians' OA severity ratings. This research sought to empirically identify physician and patient characteristics that lead to a patient being perceived as having more severe OA. METHODS Data were analyzed from the OA IX Disease Specific Program, a large cross-sectional survey of OA physicians and patients in Germany, the UK, and USA between September 2011 and January 2012. Eligible, consenting physicians completed a Patient Record Form (PRF) for 10 consecutive OA patients. The PRF asked physicians to report the patient's demographics [age, gender, body mass index (BMI), ethnicity], their assessment of the patients' symptom severity, treatment, probability for surgery, to rate their overall OA severity (mild, moderate or severe) and the factors that had influenced the rating. Chi-squared tests and analysis of variance were used to identify patient characteristics that significantly impacted physicians' OA severity ratings. Controlling for the significant patient characteristics, we then examined the impact of physician specialty on physician's OA severity ratings. Finally, we investigated the differences in physician-reported factors that influenced the physicians' rating of patients' severity between physician specialties. RESULTS Three hundred and sixty-three physicians [220 primary care physicians (PCPs), 48 rheumatologists, 95 orthopedic surgeons] recruited 3561 patients. Patients with greater age and BMI, worse symptoms and greater health care use were given higher OA severity ratings. Controlling for these factors, orthopedic surgeons rated their OA patients as more severe than PCPs and rheumatologists [adjusted odds ratio (OR) 1.8, 95% confidence interval (CI) 1.4-2.4]. Specialists (rheumatologists and orthopedic surgeons) were more likely than PCPs to use joint spaced narrowing based on X-ray and severity of joint deterioration radiographic severity to assess patients' OA severity (joint space narrowing: 79% and 78% vs 55%, P < 0.0001). CONCLUSIONS Patient age, BMI, presence and severity of symptoms and health care use significantly impacted physicians' OA severity ratings, but radiographic changes appeared to be given greater weight among orthopedic surgeons and rheumatologists than PCPs when assessing patient severity. Whether these differences translate into different treatment recommendations for similar patients is unknown, and warrants study.
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Affiliation(s)
- J Bailey
- Adelphi Real World, Macclesfield, Cheshire, UK.
| | - G A Hawker
- Women's College Research Institute, Women's College Hospital & University of Toronto, Canada.
| | - R Wood
- Adelphi Real World, Macclesfield, Cheshire, UK.
| | | | - V Higgins
- Adelphi Real World, Macclesfield, Cheshire, UK.
| | - N Joyce
- Pfizer Inc, Groton, CT, USA.
| | - M-A Hsu
- Pfizer Inc, Groton, CT, USA.
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Hussain M, Nasir S, Moed A, Murtaza G. Variations in Practice Patterns among Neurosurgeons and Orthopaedic Surgeons in the Management of Spinal Disorders. Asian Spine J 2011; 5:208-12. [PMID: 22164314 DOI: 10.4184/asj.2011.5.4.208] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Revised: 04/09/2011] [Accepted: 04/25/2011] [Indexed: 12/05/2022] Open
Abstract
Study Design This is a case series. Purpose We wanted to identify variations in the practice patterns among neurosurgeons and orthopedic surgeons for the management of spinal disorders. Overview of Literature Spinal disorders are common in the clinical practice of both neurosurgeons and orthopedic surgeons. It has been observed that despite the availability of various guidelines, there is lack of consensus among surgeons about the management of various disorders. Methods A questionnaire was distributed, either directly or via e-mail, to the both the neurosurgeons and orthopedic surgeons who worked at 5 tertiary care centers within a single region of Korea. The surgeons were working either in private practice or in academic institutions. The details of the questionnaire included demographic details and the specialty (orthopedic/neurosurgeon). The surgeons were classified according to the level of experience as up to 5 years, 6-10 years and > 10 years. Questions were asked about the approach to lumbar discectomy (fragmentectomy or aggressive disc removal), using steroids for treating discitis, the fusion preference for spondylolisthesis, the role of an orthosis after fusion, the preferred surgical approach for spinal stenosis, the operative approach for spinal trauma (early within 72 hours or late > 72 hours) and the role of surgery in complete spinal cord injury. The data was analyzed using SPSS ver 16. p-values < 0.05 were considered to be significant. Results Of the 30 surgeons who completed the questionnaire, 20 were neurosurgeons and 10 were orthopedic surgeons. Statistically significant differences were observed for the management of spinal stenosis, spondylolisthesis, using an orthosis after fusion, the type of lumbar discectomy and the value of surgical intervention after complete spinal cord injury. Conclusions Our results suggest that there continues to exist a statistically significant lack of consensus among neurosurgeons and orthopedic spine surgeons when considering using an orthosis after fusion, the type of discectomy and the value of intervention after complete spinal injury.
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