-
Systematic Reviews Dec 2018Achilles tendon ruptures are a common injury and are increasing in incidence. Several management strategies exist for both non-operative and operative care, with each...
BACKGROUND
Achilles tendon ruptures are a common injury and are increasing in incidence. Several management strategies exist for both non-operative and operative care, with each strategy offering unique risks and benefits. Traditional pairwise meta-analyses have been performed to compare management strategies; however, all treatment options have never been integrated in a single analysis. Network meta-analysis (NMA) is a generalization of pairwise meta-analysis, which allows for the comparison of multiple interventions based on all available direct and indirect evidence. The objectives of this review are to synthesize the evidence on the management options for acute Achilles tendon rupture and identify which treatment gives the best functional outcomes.
METHODS
A systematic review with NMA is planned. An electronic literature search will be performed in conjunction with an experienced information specialist in MEDLINE, EMBASE, CINAHL, PEDro, and the Cochrane Central Register of Controlled Trials. We will include randomized controlled trials with a minimum 6-month follow-up. Two independent reviewers will screen citations for eligibility, extract study data, and perform risk of bias assessments. The primary outcome will be disease-specific functional outcome scores (AOFAS, Leppilahti, modified Leppilahti) at 1 year. Secondary outcomes will include complications (re-rupture, sural nerve injury, wound complications, deep infection, secondary surgeries), strength, range of motion, return to work, return to sport, and quality-of-life measures (including the SF-36 questionnaire). Traditional pairwise meta-analyses will be performed for all direct comparisons where evidence is available, and NMAs will subsequently be performed where possible to compare all management strategies.
DISCUSSION
The data generated from this review will provide health-care providers with a clear evidence synthesis of all Achilles tendon rupture management strategies. Additionally, these data will be incorporated into the development of a patient decision aid to assist patients and clinicians in making a preference-based decision when faced with an Achilles tendon rupture.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO CRD42018093033 .
Topics: Humans; Achilles Tendon; Network Meta-Analysis; Orthopedics; Physical Therapy Modalities; Postoperative Complications; Randomized Controlled Trials as Topic; Rupture; Surgical Procedures, Operative; Meta-Analysis as Topic; Systematic Reviews as Topic
PubMed: 30580763
DOI: 10.1186/s13643-018-0912-5 -
Seminars in Pediatric Surgery Apr 2018Ambulatory pediatric surgery has become increasingly common in recent years, with greater numbers of procedures being performed on an outpatient basis. This practice has... (Review)
Review
Ambulatory pediatric surgery has become increasingly common in recent years, with greater numbers of procedures being performed on an outpatient basis. This practice has clear benefits for hospitals and healthcare providers, but patients and families also often prefer outpatient surgery for a variety of reasons. However, maximizing the potential opportunities requires critical attention to patient and procedure selection, as well as anesthetic choice. A subset of outpatient procedures can be performed as single visit procedures, further simplifying the process for families and providers.
Topics: Ambulatory Surgical Procedures; Anesthesia; Child; Humans; Patient Selection; Pediatrics; Specialties, Surgical
PubMed: 29548355
DOI: 10.1053/j.sempedsurg.2018.02.003 -
Biometrics Sep 2023Rerandomization discards assignments with covariates unbalanced in the treatment and control groups to improve estimation and inference efficiency. However, the...
Rerandomization discards assignments with covariates unbalanced in the treatment and control groups to improve estimation and inference efficiency. However, the acceptance-rejection sampling method used in rerandomization is computationally inefficient. As a result, it is time-consuming for rerandomization to draw numerous independent assignments, which are necessary for performing Fisher randomization tests and constructing randomization-based confidence intervals. To address this problem, we propose a pair-switching rerandomization (PSRR) method to draw balanced assignments efficiently. We obtain the unbiasedness and variance reduction of the difference-in-means estimator and show that the Fisher randomization tests are valid under PSRR. Moreover, we propose an exact approach to invert Fisher randomization tests to confidence intervals, which is faster than the existing methods. In addition, our method is applicable to both nonsequentially and sequentially randomized experiments. We conduct comprehensive simulation studies to compare the finite-sample performance of the proposed method with that of classical rerandomization. Simulation results indicate that PSRR leads to comparable power of Fisher randomization tests and is 3-23 times faster than classical rerandomization. Finally, we apply the PSRR method to analyze two clinical trial datasets, both of which demonstrate the advantages of our method.
Topics: Research Design; Computer Simulation; Sample Size
PubMed: 35758335
DOI: 10.1111/biom.13712 -
BMC Medical Research Methodology Dec 2014In systematic reviews and meta-analysis, researchers often pool the results of the sample mean and standard deviation from a set of similar clinical trials. A number of...
BACKGROUND
In systematic reviews and meta-analysis, researchers often pool the results of the sample mean and standard deviation from a set of similar clinical trials. A number of the trials, however, reported the study using the median, the minimum and maximum values, and/or the first and third quartiles. Hence, in order to combine results, one may have to estimate the sample mean and standard deviation for such trials.
METHODS
In this paper, we propose to improve the existing literature in several directions. First, we show that the sample standard deviation estimation in Hozo et al.'s method (BMC Med Res Methodol 5:13, 2005) has some serious limitations and is always less satisfactory in practice. Inspired by this, we propose a new estimation method by incorporating the sample size. Second, we systematically study the sample mean and standard deviation estimation problem under several other interesting settings where the interquartile range is also available for the trials.
RESULTS
We demonstrate the performance of the proposed methods through simulation studies for the three frequently encountered scenarios, respectively. For the first two scenarios, our method greatly improves existing methods and provides a nearly unbiased estimate of the true sample standard deviation for normal data and a slightly biased estimate for skewed data. For the third scenario, our method still performs very well for both normal data and skewed data. Furthermore, we compare the estimators of the sample mean and standard deviation under all three scenarios and present some suggestions on which scenario is preferred in real-world applications.
CONCLUSIONS
In this paper, we discuss different approximation methods in the estimation of the sample mean and standard deviation and propose some new estimation methods to improve the existing literature. We conclude our work with a summary table (an Excel spread sheet including all formulas) that serves as a comprehensive guidance for performing meta-analysis in different situations.
Topics: Algorithms; Biomedical Research; Computer Simulation; Humans; Meta-Analysis as Topic; Reproducibility of Results; Review Literature as Topic; Sample Size; Statistics as Topic
PubMed: 25524443
DOI: 10.1186/1471-2288-14-135 -
Medizinische Klinik, Intensivmedizin... Oct 2022Extracorporeal cardiopulmonary resuscitation (eCPR) is the implementation of extracorporeal membrane oxygenation (ECMO) in selected patients with cardiac arrest and may... (Review)
Review
Extracorporeal cardiopulmonary resuscitation (eCPR) is the implementation of extracorporeal membrane oxygenation (ECMO) in selected patients with cardiac arrest and may be considered when conventional CPR efforts fail, as written in the latest international guidelines. eCPR is a complex intervention that requires a highly trained team, specialized equipment, and multidisciplinary support within a healthcare system and it has the risk of several life-threatening complications. However, there are no randomized, controlled studies on eCPR, and valid predictors of benefit and outcome are lacking. Therefore, optimal timing, patient selection, location and method of implementation vary across centers. As utilization of eCPR has increased in recent years and more centers begin to perform eCPR, considerable uncertainties exist in the prehospital setting as well as in the emergency room. However, structured communication and clearly defined processes are essential especially at the interface between prehospital rescue teams and the eCPR team to achieve the highest possible benefit for cardiac arrest patients using eCPR. This article presents an algorithm for structured, evidence-based logistic considerations, patient selection, and implementation of eCPR as well as early care after establishment of extracorporeal life support (ECLS) which are mainly based on the German national recommendations for eCPR of DGIIN, DGK, DGTHG, DGfK, DGNI, DGAI, DIVI and GRC published in 2019 as well as the S3 guideline "Use of extracorporeal circulation (ECLS/ECMO) for cardiac and circulatory failure" and local standard operating procedures of the authors.
Topics: Cardiopulmonary Resuscitation; Emergency Service, Hospital; Extracorporeal Membrane Oxygenation; Heart Arrest; Humans; Out-of-Hospital Cardiac Arrest; Patient Selection; Retrospective Studies
PubMed: 33835193
DOI: 10.1007/s00063-021-00796-2 -
Annals of Physical and Rehabilitation... Jun 2016There are two main surgical treatments for osteoarthritis: conservative treatments, where the damaged cartilage is left in place, and radical treatments, where the... (Review)
Review
There are two main surgical treatments for osteoarthritis: conservative treatments, where the damaged cartilage is left in place, and radical treatments, where the cartilage is replaced by an artificial endoprosthesis; this latter procedure is termed joint arthroplasty. These treatments are only offered to symptomatic patients. Arthrodesis is yet another surgical intervention in cases of osteoarthritis. It will sacrifice the joint's articular function and is performed on small osteoarthritic joints, such as wrists and ankles, for instance. Osteoarthritis symptoms are usually the consequence of an imbalance between the load applied to a joint and the surface available to support that load. Therefore, conservative treatments will either tend to decrease the load exerted on the joint, such as in a tibial valgus osteotomy for instance, or to improve the articular surface supporting that load. Sometimes, both can be provided at the same time; the peri-acetabular osteotomy for hip dysplasia is an example of such a procedure. Conservative treatments are usually offered to young patients in order to delay, if not avoid, the need for a joint prosthesis. They are usually performed before osteoarthritis appears or at an early stage. Joint arthroplasties have overwhelmingly excellent functional results and today's research is directed towards providing rapid recovery, very long-term stability, and the assurance of a good functionality in extreme conditions. However, complications with joint arthroplasties can be serious with little, if any, reasonable salvage solution. Therefore, these procedures are offered to patients who have failed adequate medical treatment measures.
Topics: Adult; Arthrodesis; Arthroplasty; Humans; Osteoarthritis; Osteotomy; Patient Selection
PubMed: 27185463
DOI: 10.1016/j.rehab.2016.04.003 -
Asian Journal of Andrology 2016Vasectomy is a safe and effective method of contraception used by 42-60 million men worldwide. Approximately 3%-6% of men opt for a vasectomy reversal due to the death... (Review)
Review
Vasectomy is a safe and effective method of contraception used by 42-60 million men worldwide. Approximately 3%-6% of men opt for a vasectomy reversal due to the death of a child or divorce and remarriage, change in financial situation, desire for more children within the same marriage, or to alleviate the dreaded postvasectomy pain syndrome. Unlike vasectomy, vasectomy reversal is a much more technically challenging procedure that is performed only by a minority of urologists and places a larger financial strain on the patient since it is usually not covered by insurance. Interest in this procedure has increased since the operating microscope became available in the 1970s, which consequently led to improved patency and pregnancy rates following the procedure. In this clinical update, we discuss patient evaluation, variables that may influence reversal success rates, factors to consider in choosing to perform vasovasostomy versus vasoepididymostomy, and the usefulness of vasectomy reversal to alleviate postvasectomy pain syndrome. We also review the use of robotics for vasectomy reversal and other novel techniques and instrumentation that have emerged in recent years to aid in the success of this surgery.
Topics: Chronic Pain; Family Characteristics; Female; Humans; Male; Microsurgery; Pain, Postoperative; Patient Selection; Pregnancy; Pregnancy Rate; Prognosis; Testicular Diseases; Urologic Surgical Procedures, Male; Vasovasostomy
PubMed: 26975488
DOI: 10.4103/1008-682X.175091 -
Expert Review of Cardiovascular Therapy Dec 2019: Transcatheter tricuspid valve (TV) procedures emerged as an alternative to surgery for symptomatic high-risk patients with severe tricuspid regurgitation.: A... (Review)
Review
: Transcatheter tricuspid valve (TV) procedures emerged as an alternative to surgery for symptomatic high-risk patients with severe tricuspid regurgitation.: A literature search was performed using PubMed. Authors review clinical evidence in this field, the imaging features and the developments in TV transcatheter technologies. Currently, transcatheter devices for TV procedures can be allocated into four main groups: 1) those ones targeting leaflet malcoaptation, 2) those addressing annular dilatation, 3) those performing heterotopic valve implantation and 4) those onesaccomplishing a complete transcatheter replacement of the valve.: Actually, encouraging results are provided by initial experience in the field of transcatheter TV procedures. However, this field remains full of challenges that faced could lead to better results and prognosis for the patients. The next steps in this emerging field will need to focus on accurate patient selection, an early patient referral and on studies comparable and providing long-term data.
Topics: Cardiac Catheterization; Heart Valve Prosthesis Implantation; Humans; Patient Selection; Treatment Outcome; Tricuspid Valve; Tricuspid Valve Insufficiency
PubMed: 31795771
DOI: 10.1080/14779072.2019.1699056 -
Pharmaceutical Statistics 2023We introduce a new two-sample inference procedure to assess the relative performance of two groups over time. Our model-free method does not assume proportional hazards,...
We introduce a new two-sample inference procedure to assess the relative performance of two groups over time. Our model-free method does not assume proportional hazards, making it suitable for scenarios where nonproportional hazards may exist. Our procedure includes a diagnostic tau plot to identify changes in hazard timing and a formal inference procedure. The tau-based measures we develop are clinically meaningful and provide interpretable estimands to summarize the treatment effect over time. Our proposed statistic is a U-statistic and exhibits a martingale structure, allowing us to construct confidence intervals and perform hypothesis testing. Our approach is robust with respect to the censoring distribution. We also demonstrate how our method can be applied for sensitivity analysis in scenarios with missing tail information due to insufficient follow-up. Without censoring, Kendall's tau estimator we propose reduces to the Wilcoxon-Mann-Whitney statistic. We evaluate our method using simulations to compare its performance with the restricted mean survival time and log-rank statistics. We also apply our approach to data from several published oncology clinical trials where nonproportional hazards may exist.
Topics: Humans; Proportional Hazards Models; Neoplasms; Medical Oncology; Research Design; Survival Analysis
PubMed: 37429738
DOI: 10.1002/pst.2324 -
The Bone & Joint Journal Sep 2016A variety of operative techniques have been described as under the term 'Bristow-Latarjet' procedure. This review aims to define the original procedure, and compare the... (Comparative Study)
Comparative Study Review
OBJECTIVES
A variety of operative techniques have been described as under the term 'Bristow-Latarjet' procedure. This review aims to define the original procedure, and compare the variation in techniques described in the literature, assessing any effect on clinical outcomes.
MATERIALS AND METHODS
A systematic review of 24 studies was performed to compare specific steps of the technique (coracoid osteotomy site, subscapularis approach, orientation and position of coracoid graft fixation and fixation method, additional labral and capsular repair) and detect any effect this variability had on outcomes.
RESULTS
Overall recurrence rate was 5.36% (2.94% to 43%). Half of the studies performed the procedure for recurrent shoulder instability, with only five studies documenting glenoid bone loss as an indication: 12 studies used the procedure as the primary surgical intervention for recurrent instability. No change in outcome was noted when examining variation in the coracoid osteotomy site, the fixation site on the scapular neck, the fixation method or whether a capsular repair was also performed. Performing a horizontal split in subscapularis may preserve external rotation compared with performing a tenotomy.
CONCLUSIONS
This is the first review to examine various operative techniques of the Bristow-Latarjet procedure, and their effect on outcome. We found that other than the approach through subscapularis, outcome was independent of the surgical technique, and depended more on patient selection. We would commend future publications on this procedure to provide a detailed description of the surgical technique, and as a minimum present rates of recurrence as an outcome measure. Cite this article: Bone Joint J 2016;98-B:1208-14.
Topics: Adult; Arthroscopy; Bone Screws; Female; Humans; Joint Capsule; Joint Instability; Male; Orthopedic Procedures; Osteotomy; Pain Measurement; Patient Selection; Prognosis; Range of Motion, Articular; Recurrence; Risk Assessment; Shoulder Dislocation; Young Adult
PubMed: 27587522
DOI: 10.1302/0301-620X.98B9.37948