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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 -
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 -
Medical Education Jan 2010Findings from the contemporary psychological and movement science literature that appear to have implications for medical training are reviewed. Specifically, the review... (Review)
Review
OBJECTIVES
Findings from the contemporary psychological and movement science literature that appear to have implications for medical training are reviewed. Specifically, the review focuses on four factors that have been shown to enhance the learning of motor skills: observational practice; the learner's focus of attention; feedback, and self-controlled practice.
OBSERVATIONAL PRACTICE
Observation of others, particularly when it is combined with physical practice, can make important contributions to learning. This includes dyad practice (i.e. practice in pairs), which is not only cost-effective, but can also enhance learning.
FOCUS OF ATTENTION
Studies examining the role of the performer's focus of attention have consistently demonstrated that instructions inducing an external focus (directed at the movement effect) are more effective than those promoting an internal focus (directed at the performer's body movements). An external focus facilitates automaticity in motor control and promotes movement efficiency.
FEEDBACK
Feedback not only has an informational function, but also has motivational properties that have an important influence on learning. For example, feedback after successful trials and social-comparative (normative) feedback indicating better than average performance have been shown to have a beneficial effect on learning. SELF-CONTROLLED PRACTICE: Self-controlled practice, including feedback and model demonstrations controlled by the learner, has been found to be more effective than externally controlled practice conditions.
CONCLUSIONS
All factors reviewed in this article appear to have both informational and motivational influences on learning. The findings seem to reflect general learning principles and are assumed to have relatively broad applicability. Therefore, the consideration of these factors in designing procedures for medical training has the potential to enhance the effectiveness and efficiency of training.
Topics: Attention; Education, Medical; Feedback, Psychological; Humans; Motor Skills; Observation; Practice, Psychological; Psychomotor Performance
PubMed: 20078758
DOI: 10.1111/j.1365-2923.2009.03421.x -
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 -
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 -
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 -
The Surgical Clinics of North America Dec 1988A well-performed hemorrhoidectomy is the procedure of choice for fourth-degree prolapsing irreducible hemorrhoids (including thrombosed prolapsed hemorrhoids) and most...
A well-performed hemorrhoidectomy is the procedure of choice for fourth-degree prolapsing irreducible hemorrhoids (including thrombosed prolapsed hemorrhoids) and most third-degree hemorrhoids. It eliminates the vascular cushions, produces mucosal fixation, and eliminates the anal stenosis. Although open hemorrhoidectomy is performed in some centers, the majority of colon and rectal surgeons perform closed hemorrhoidectomy by the Ferguson technique, which has been modified by the author and colleagues, with satisfactory results.
Topics: Hemorrhoids; Humans; Methods
PubMed: 3194822
DOI: 10.1016/s0039-6109(16)44696-7 -
Hand Clinics Nov 2005Proximal row carpectomy is extremely useful as a wrist reconstructive technique for cases of degenerative joint arthritis of the radiocarpal joint cause by scapholunate... (Review)
Review
Proximal row carpectomy is extremely useful as a wrist reconstructive technique for cases of degenerative joint arthritis of the radiocarpal joint cause by scapholunate advanced collapse, scapholunate advanced collapse, schaphoid nonunion advanced collapse, trans-scaphoid perilunate fracture dislocations, lunate dislocations, and Kienböck disease. It should be selected with caution for patients younger than 35 years old. The procedure can be performed with or without temporary internal fixation with with Kirschner wires, and adjunctive techniques of dorsal capsule interposition, proximal capitate excision, and radial styloidectomy can be used. The longevity of the operation is good, but the patient should be informed preoperatively that secondary procedures may be required. Based on historical series, these procedures have included addition have included of radial styloidectomy when this has not been performed at the index procedure, revision of the surgery with capitate debridement or conversion to total wrist arthodesis. Conversion of proximal row carpectomy to total wrist arthoplasty with implants can be contemplated in selected patient particularly as newer implants are designed. The technique the senior author has used on occasion has been to perform revision surgery on those patients who have chronic pain who might need further debridement of the radius in the radial styloid, the proximal capitate, or evaluation of the integrity of the interposition.
Topics: Adult; Aged; Carpal Bones; Humans; Joint Diseases; Male; Patient Selection; Treatment Outcome
PubMed: 16274865
DOI: 10.1016/j.hcl.2005.08.006 -
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 -
Clinics in Plastic Surgery Jul 2013Ambulatory surgery is commonplace for a multitude of procedures and a wide range of patients. The types of procedures performed in the ambulatory setting are becoming... (Review)
Review
Ambulatory surgery is commonplace for a multitude of procedures and a wide range of patients. The types of procedures performed in the ambulatory setting are becoming more work-intensive, and patients with comorbidities make for a challenging environment. For a safe environment for surgery in ambulatory facilities, the complex task of patient selection is necessary. Until an algorithm is created that includes provider, procedure, facility, and patient comorbidites, clinicians must rely on general guidelines rather than precise recommendations.
Topics: Ambulatory Surgical Procedures; Humans; Patient Compliance; Patient Selection
PubMed: 23830745
DOI: 10.1016/j.cps.2013.04.004