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1.
Braz. j. biol ; 84: e253215, 2024. tab
Artigo em Inglês | LILACS-Express | LILACS, VETINDEX | ID: biblio-1360216

RESUMO

Abstract Frequencies, magnitudes, and distributions of occurrence can affect the events. The problem can be worse or the solution better if greater frequencies and magnitudes are presented with aggregated distribution in the production system. Indices, hence, are used to assist in decision-making on certain issues. The system formed by Caryocar brasiliense Camb. (Malpighiales: Caryocaraceae), a typical and economically important Brazilian Cerrado tree species, and its several arthropods are adequate to evaluate a new index. This study aimed to test an index to identify the loss and solution sources and their importance in the system's loss or income gain. The index is: Percentage of Importance Indice % I . I . = k s 1 × c 1 × d s 1 / Σ k s 1 × c 1 × d s 1 + k s 2 × c 2 × d s 2 + k s n × c n × d s n x 100. T h e % I . I . separated the loss sources [e.g., Edessa rufomarginata De Geer, 1773 (Hemiptera: Pentatomidae) on fruits = 41.90%)] on the percentage of reduction of fruit production (e.g., 0.13%), calculated the attention level (e.g., 0.10/fruit), with a total lost production of 1.35% (≈ 307 total lost fruits). The % I.I. also separated the solution sources [e.g., Zelus armillatus (Lep. and Servi., 1825) (Hemiptera: Reduviidae) = 55.48%), the non-attention level (e.g., Z. armillatus: 0.394 for E. rufomarginata on fruit), with total income gain of 0.56% (≈ 128 total saved fruits) on the natural system (e.g., C. brasiliense trees). This index can calculate losses or the effectiveness of the solutions monetarily. Here I test the % I.I., an index that can detect the key loss and solution sources on the system, which can be applied in some knowledge areas.


Resumo Frequências, magnitudes e distribuição de ocorrência pode afetar os eventos. O problema pode ser pior ou a solução melhor se maiores frequências e magnitudes forem apresentadas com distribuição agregada no sistema de produção. Índices, então, são usados para assistir na decisão de certas questões. O sistema formado pelo Caryocar brasiliense Camb. (Malpighiales: Caryocaraceae), uma espécie arbórea típica e economicamente importante do Cerrado brasileiro, e seus diversos artrópodes são adequados para avaliar um novo índice. A motivação deste trabalho foi testar um índice capaz de identificar as fontes de perda e de soluções, e suas importâncias em termos de perdas ou ganhos no sistema. O índice é: percentagem de importância % I . I . = k s 1 × c 1 × d s 1 / Σ k s 1 × c 1 × d s 1 + k s 2 × c 2 × d s 2 + k s n × c n × d s n x 100. O % I . I . separou as fontes de perda [ex., Edessa rufomarginata De Geer, 1773 (Hemiptera: Pentatomidae) em frutos = 41,90%)] na percentagem de redução na produção de frutos (ex., 0,13%), calculando o nível de atenção (ex., 0,10/fruto), com um total de perda de produção de 1,35% (≈ 307 frutos totais perdidos). O % I.I. também separou as fontes de solução [ex., Zelus armillatus (Lep. and Servi., 1825) (Hemiptera: Reduviidae) = 55,48%)], o nível de não atenção (ex., Z. armillatus: 0,394 para E. rufomarginata em fruto), com total de ganho de 0,56% (≈ 128 total de frutos salvos) no sistema natural (ex., árvores de C. brasiliense). Esse índice pode calcular essas perdas ou a eficácia das soluções monetariamente. Aqui eu testo o % I.I., um índice capaz de detectar fatores chaves de perda e de soluções no sistema, capaz de ser aplicado em algumas áreas do conhecimento.

2.
Braz. j. biol ; 84: e253218, 2024. tab
Artigo em Inglês | LILACS, VETINDEX | ID: biblio-1355863

RESUMO

Abstract Indices are used to help on decision-making. This study aims to develop and test an index, which can determine the loss (e.g., herbivorous insects) and solution (e.g., natural enemies) sources. They will be classified according to their importance regarding the ability to damage or to reduce the source of damage to the system when the final production is unknown. Acacia auriculiformis (Fabales: Fabaceae), a non-native pioneer species in Brazil with fast growth and rusticity, is used in restoration programs, and it is adequate to evaluate a new index. The formula was: Percentage of the Importance Indice-Production Unknown (% I.I.-PU) = [(ks1 x c1 x ds1)/Σ (ks1 x c1 x ds1) + (ks2 x c2 x ds2) + (ksn x cn x dsn)] x 100. The loss sources Aethalion reticulatum L., 1767 (Hemiptera: Aethalionidae), Aleyrodidae (Hemiptera), Stereoma anchoralis Lacordaire, 1848 (Coleoptera: Chrysomelidae), and Tettigoniidae, and solution sources Uspachus sp. (Araneae: Salticidae), Salticidae (Araneae), and Pseudomyrmex termitarius (Smith, 1877) (Hymenoptera: Formicidae) showed the highest % I.I.-PU on leaves of A. auriculiformis saplings. The number of Diabrotica speciosa Germar, 1824 (Coleoptera: Chrysomelidae) was reduced per number of Salticidae; that of A. reticulatum that of Uspachus sp.; and that of Cephalocoema sp. (Orthoptera: Proscopiidae) that of P. termitarius on A. auriculiformis saplings. However, the number of Aleyrodidae was increased per number of Cephalotes sp. (Hymenoptera: Formicidae) and that of A. reticulatum that of Brachymyrmex sp. (Hymenoptera: Formicidae) on A. auriculiformis saplings. The A. reticulatum damage was reduced per number of Uspachus sp., but the Aleyrodidae damage was increased per number of Cephalotes sp., totaling 23.81% of increase by insect damages on A. auriculiformis saplings. Here I show and test the % I.I.-PU. It is an new index that can detect the loss or solution sources on a system when production is unknown. It can be applied in some knowledge areas.


Resumo Índices são usados para ajudar na tomada de decisões. Este trabalho teve como objetivo desenvolver e testar um índice capaz de determinar fontes de perda (ex.: insetos herbívoros) e de solução (ex.: inimigos naturais). Eles serão classificados de acordo com sua importância quanto a habilidade de danificar ou reduzir danos no sistema, quando a produção final é desconhecida. Acacia auriculiformis (Fabales: Fabaceae), uma espécie pioneira não nativa do Brasil com rápido crescimento e rusticidade, usada em programas de restauração, é adequada para avaliar um novo índice. A fórmula foi: Porcentagem de Índice de Importância-Produção Desconhecida (% I.I.-PD) = [(ks1 x c1 x ds1)/Σ (ks1 x c1 x ds1) + (ks2 x c2 x ds2) + (ksn x cn x dsn)] x 100. As fontes de perda Aethalion reticulatum L., 1767 (Hemiptera: Aethalionidae), Aleyrodidae (Hemiptera), Stereoma anchoralis Lacordaire, 1848 (Coleoptera: Chrysomelidae) e Tettigoniidae, e as fontes de solução Uspachus sp. (Araneae: Salticidae), Salticidae (Araneae) e Pseudomyrmex termitarius (Smith, 1877) (Hymenoptera: Formicidae) apresentaram maiores % I.I.-PD nas folhas das mudas de A. auriculiformis. O número de Diabrotica speciosa Germar, 1824 (Coleoptera: Chrysomelidae) foi reduzido pelo número de Salticidae; o de A. reticulatum pelo de Uspachus sp.; e o de Cephalocoema sp. (Orthoptera: Proscopiidae) pelo de P. termitarius em mudas de A. auriculiformis. Entretanto, o número de Aleyrodidae foi aumentado pelo número de Cephalotes sp. (Hymenoptera: Formicidae) e o de A. reticulatum pelo de Brachymyrmex sp. (Hymenoptera: Formicidae) em mudas de A. auriculiformis. O dano de A. reticulatum foi reduzido pelo número de Uspachus sp., mas o dano de Aleyrodidae foi aumentado pelo número de Cephalotes sp., totalizando 23,81% de aumento de danos em mudas de A. auriculiformis. Aqui eu apresento e testo o % I.I.-PD. Ele é um novo índice capaz de detectar fontes de perda e de solução no sistema quando não se conhece a produção final. Ele pode ser aplicado em algumas áreas do conhecimento.


Assuntos
Animais , Formigas , Besouros , Acacia , Hemípteros , Insetos
3.
Bone Jt Open ; 3(7): 543-548, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35801582

RESUMO

AIMS: Although readmission has historically been of primary interest, emergency department (ED) visits are increasingly a point of focus and can serve as a potentially unnecessary gateway to readmission. This study aims to analyze the difference between primary and revision total joint arthroplasty (TJA) cases in terms of the rate and reasons associated with 90-day ED visits. METHODS: We retrospectively reviewed all patients who underwent TJA from 2011 to 2021 at a single, large, tertiary urban institution. Patients were separated into two cohorts based on whether they underwent primary or revision TJA (rTJA). Outcomes of interest included ED visit within 90-days of surgery, as well as reasons for ED visit and readmission rate. Multivariable logistic regressions were performed to compare the two groups while accounting for all statistically significant demographic variables. RESULTS: Overall, 28,033 patients were included, of whom 24,930 (89%) underwent primary and 3,103 (11%) underwent rTJA. The overall rate of 90-day ED visits was significantly lower for patients who underwent primary TJA in comparison to those who underwent rTJA (3.9% vs 7.0%; p < 0.001). Among those who presented to the ED, the readmission rate was statistically lower for patients who underwent primary TJA compared to rTJA (23.5% vs 32.1%; p < 0.001). CONCLUSION: ED visits present a significant burden to the healthcare system. Patients who undergo rTJA are more likely to present to the ED within 90 days following surgery compared to primary TJA patients. However, among patients in both cohorts who visited the ED, three-quarters did not require readmission. Future efforts should aim to develop cost-effective and patient-centred interventions that can aid in reducing preventable ED visits following TJA. Cite this article: Bone Jt Open 2022;3(7):543-548.

4.
Bone Joint J ; 104-B(7): 826-832, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35775167

RESUMO

AIMS: It is not known whether preservation of the capsule of the hip positively affects patient-reported outcome measures (PROMs) in total hip arthroplasty using the direct anterior approach (DAA-THA). A recent randomized controlled trial found no clinically significant difference at one year postoperatively. This study aimed to determine whether preservation of the anterolateral capsule and anatomical closure improve the outcome and revision rate, when compared with resection of the anterolateral capsule, at two years postoperatively. METHODS: Two consecutive groups of patients whose operations were performed by the senior author were compared. The anterolateral capsule was resected in the first group of 430 patients between January 2012 and December 2014, and preserved and anatomically closed in the second group of 450 patients between July 2015 and December 2017. There were no other technical changes between the two groups. Patient characteristics, the Charlson Comorbidity Index (CCI), and surgical data were collected from our database. PROM questionnaires, consisting of the Oxford Hip Score (OHS) and Core Outcome Measures Index (COMI-Hip), were collected two years postoperatively. Data were analyzed with generalized multiple regression analysis. RESULTS: The characteristics, CCI, operating time, and length of stay were similar in both groups. There was significantly less blood loss in the capsular preservation group (p = 0.037). The revision rate (n = 3, (0.6%) in the resected group, and 1 (0.2%) in the preserved group) did not differ significantly (p = 0.295). Once adjusted for demographic and surgical factors, the preserved group had significantly worse PROMs: + 0.24 COMI-Hip (p < 0.001) and -1.6 OHS points (p = 0.017). However, the effect sizes were much smaller than the minimal clinically important differences (MCIDs) of 0.95 and 5, respectively). The date of surgery (influencing, for instance, the surgeon's age) was not a significant factor. CONCLUSION: Based on the MCID, the lower PROMs in the capsular preservation group do not seem to have clinical relevance. They do not, however, confirm the expected benefit of capsular preservation reported for the posterolateral approach. Cite this article: Bone Joint J 2022;104-B(7):826-832.


Assuntos
Artroplastia de Quadril , Antivirais , Artroplastia de Quadril/efeitos adversos , Humanos , Diferença Mínima Clinicamente Importante , Medidas de Resultados Relatados pelo Paciente , Resultado do Tratamento
5.
Bone Jt Open ; 3(8): 582-588, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35848996

RESUMO

AIMS: Preprint servers allow authors to publish full-text manuscripts or interim findings prior to undergoing peer review. Several preprint servers have extended their services to biological sciences, clinical research, and medicine. The purpose of this study was to systematically identify and analyze all articles related to Trauma & Orthopaedic (T&O) surgery published in five medical preprint servers, and to investigate the factors that influence the subsequent rate of publication in a peer-reviewed journal. METHODS: All preprints covering T&O surgery were systematically searched in five medical preprint servers (medRxiv, OSF Preprints, Preprints.org, PeerJ, and Research Square) and subsequently identified after a minimum of 12 months by searching for the title, keywords, and corresponding author in Google Scholar, PubMed, Scopus, Embase, Cochrane, and the Web of Science. Subsequent publication of a work was defined as publication in a peer-reviewed indexed journal. The rate of publication and time to peer-reviewed publication were assessed. Differences in definitive publication rates of preprints according to geographical origin and level of evidence were analyzed. RESULTS: The number of preprints increased from 2014 to 2020 (p < 0.001). A total of 38.6% of the identified preprints (n = 331) were published in a peer-reviewed indexed journal after a mean time of 8.7 months (SD 5.4 (1 to 27)). The highest proportion of missing subsequent publications was in the preprints originating from Africa, Asia/Middle East, and South America, or in those that covered clinical research with a lower level of evidence (p < 0.001). CONCLUSION: Preprints are being published in increasing numbers in T&O surgery. Depending on the geographical origin and level of evidence, almost two-thirds of preprints are not subsequently published in a peer-reviewed indexed journal after one year. This raises major concerns regarding the dissemination and persistence of potentially wrong scientific work that bypasses peer review, and the orthopaedic community should discuss appropriate preventive measures.Cite this article: Bone Jt Open 2022;3(7):582-588.

6.
J Appl Stat ; 49(1): 24-43, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35707803

RESUMO

Several methods for comparing k populations have been proposed in the literature. These methods assess the same null hypothesis of equal distributions but differ in the alternative hypothesis they consider. We focus on two important alternative hypotheses: monotone and umbrella ordering. Two new families of test statistics are proposed, including two known tests, as well as two new powerful tests under monotone ordering. Furthermore, these families are adapted for testing umbrella ordering. We compare some members of the families with respect to power and Type I errors under different simulation scenarios. Finally, the methods are illustrated in several applications to real data.

7.
Bone Jt Open ; 3(5): 432-440, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35608348

RESUMO

AIMS: Tuberculosis (TB) is one of the biggest communicable causes of mortality worldwide. While incidence in the UK has continued to fall since 2011, Bradford retains one of the highest TB rates in the UK. This study aims to examine the local disease burden of musculoskeletal (MSK) TB, by analyzing common presenting factors within the famously diverse population of Bradford. METHODS: An observational study was conducted, using data from the Bradford Teaching Hospitals TB database of patients with a formal diagnosis of MSK TB between January 2005 and July 2017. Patient data included demographic data (including nationality/date of entry to the UK), disease focus, microbiology, and management strategies. Disease incidence was calculated using population data from the Office for National Statistics. Poisson confidence intervals were calculated to demonstrate the extent of statistical error. Disease incidence and nationality were also analyzed, and correlation sought, using the chi-squared test. RESULTS: Between January 2005 and July 2017, 109 cases of MSK TB were diagnosed in Bradford. Mean incidence was 1.65 per 100,000 population, per calendar year (SD 0.75). A total of 38 cases required surgical intervention. Low rates of antimicrobial resistance were encountered. A low rate of loss to follow-up was observed (four patients; 3.7%). Overall, 94.5% of patients (n = 103) were successfully treated. 67% of patients (n = 73) reported their country of origin as either India, Pakistan, or Bangladesh. These ethnicities account for around 25% of the local population. CONCLUSION: Bradford maintains a high prevalence of MSK TB infection relative to national data; the prevalence within the local immigrant population remains grossly disproportionate. Typical associated factors (HIV/hepatitis coinfection, drug resistance), have only modest prevalence in our dataset. However, local socioeconomic factors such as deprivation and poverty appear germane as suggested by global literature. We advocate a high degree of suspicion in treatment of atypical infection in any area with similar population factors to ensure timely diagnosis. Cite this article: Bone Jt Open 2022;3(5):432-440.

8.
Int J Biometeorol ; 66(7): 1297-1315, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35419657

RESUMO

This systematic review aims to give an overview of the diversity of research areas related to human biometeorology in Brazil. The main focus of this paper addresses research trends, represented by published papers with national and international authorship, main contributions and shortcomings, as well as challenges and prospects of research in this area of study. An extensive literature search was conducted in the Scopus, Web of Science, and Science Direct databases so as to identify relevant publication output up to July 2021 related to the research area. The screening resulted in 96 studies chosen for full-text reading. Overall, results indicated a reduced amount of articles on the subject matter published internationally, with noticeable gaps in research in some regions of the country, such as the Amazon region and in the Brazilian Midwest region. Research gaps in relevant areas have been identified with limited output in the climate dimensions of tourism, vector-borne diseases, mortality and morbidity in urban centers. Such gaps should further encourage researchers to engage in research focused on those areas.


Assuntos
Meteorologia , Pesquisadores , Brasil , Humanos , Morbidade
9.
Bone Jt Open ; 3(3): 236-244, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35293229

RESUMO

AIMS: The primary aim of this study was to determine the rates of return to work (RTW) and sport (RTS) following a humeral shaft fracture. The secondary aim was to identify factors independently associated with failure to RTW or RTS. METHODS: From 2008 to 2017, all patients with a humeral diaphyseal fracture were retrospectively identified. Patient demographics and injury characteristics were recorded. Details of pre-injury employment, sporting participation, and levels of return post-injury were obtained via postal questionnaire. The University of California, Los Angeles (UCLA) Activity Scale was used to quantify physical activity among active patients. Regression was used to determine factors independently associated with failure to RTW or RTS. RESULTS: The Work Group comprised 177 patients in employment prior to injury (mean age 47 years (17 to 78); 51% female (n = 90)). Mean follow-up was 5.8 years (1.3 to 11). Overall, 85% (n = 151) returned to work at a mean of 14 weeks post-injury (0 to 104), but only 60% (n = 106) returned full-time to their previous employment. Proximal-third fractures (adjusted odds ratio (aOR) 4.0 (95% confidence interval (CI) 1.2 to 14.2); p = 0.029) were independently associated with failure to RTW. The Sport Group comprised 182 patients involved in sport prior to injury (mean age 52 years (18 to 85); 57% female (n = 104)). Mean follow-up was 5.4 years (1.3 to 11). The mean UCLA score reduced from 6.9 (95% CI 6.6 to 7.2) before injury to 6.1 (95% CI 5.8 to 6.4) post-injury (p < 0.001). There were 89% (n = 162) who returned to sport: 8% (n = 14) within three months, 34% (n = 62) within six months, and 70% (n = 127) within one year. Age ≥ 60 years was independently associated with failure to RTS (aOR 3.0 (95% CI 1.1 to 8.2); p = 0.036). No other factors were independently associated with failure to RTW or RTS. CONCLUSION: Most patients successfully return to work and sport following a humeral shaft fracture, albeit at a lower level of physical activity. Patients aged ≥ 60 yrs and those with proximal-third diaphyseal fractures are at increased risk of failing to return to activity. Cite this article: Bone Jt Open 2022;3(3):236-244.

10.
Stat Methods Med Res ; 31(6): 1031-1050, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35345942

RESUMO

Model checking for logistic regression with covariates missing at random is considered. Based on the ideas of Copas (1989) and Osius and Rojek (1992) and studies of Homser et al. (1997), proposed are the two-type goodness-of-fit tests, Pearson chi-squared and unweighted residual sum-of-squares tests, in which their test statistics are centralized by subtracting their estimated mean to be mean-zero-form test statistics via the inverse probability weighting (IPW) and nonparametric multiple imputation (MI) methods to solve the missing value problem. The asymptotic properties of these test statistics are established under the null hypothesis and some regularity conditions. The test statistics conducted by using the IPW and MI estimators are asymptotically equivalent. Proposed are the IPW method and two bootstrap re-sampling approaches for estimation of the variances of the proposed test statistics to solve the issue of underestimating their variances by the MI method of Rubin (1987). Simulation studies are carried out to assess the finite-sample power performances of these proposed tests. Two real data examples are used to illustrate the applicability of the proposed tests.


Assuntos
Modelos Logísticos , Simulação por Computador , Interpretação Estatística de Dados , Probabilidade
11.
Biometrics ; 2022 Feb 11.
Artigo em Inglês | MEDLINE | ID: mdl-35146750

RESUMO

An estimated quadratic inference function method is proposed for correlated failure time data with auxiliary covariates. The proposed method makes efficient use of the auxiliary information for the incomplete exposure covariates and preserves the property of the quadratic inference function method that requires the covariates to be completely observed. It can improve the estimation efficiency and easily deal with the situation when the cluster size is large. The proposed estimator which minimizes the estimated quadratic inference function is shown to be consistent and asymptotically normal. A chi-squared test based on the estimated quadratic inference function is proposed to test hypotheses about the regression parameters. The small-sample performance of the proposed method is investigated through extensive simulation studies. The proposed method is then applied to analyze the Study of Left Ventricular Dysfunction (SOLVD) data as an illustration.

13.
Bone Joint J ; 104-B(2): 290-296, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-35094575

RESUMO

AIMS: Iliosacral sarcoma resections have been shown to have high rates of local recurrence (LR) and poor overall survival. There is also no universal classification for the resection of pelvic sarcomas invading the sacrum. This study proposes a novel classification system and analyzes the survival and risk of recurrence, when using this system. METHODS: This is a retrospective analysis of 151 patients (with median follow-up in survivors of 44 months (interquartile range 12 to 77)) who underwent hemipelvectomy with iliosacral resection at a single centre between 2007 and 2019. The proposed classification differentiates the extent of iliosacral resection and defines types S1 to S6 (S1 resection medial and parallel to the sacroiliac joint, S2 resection through the ipsilateral sacral lateral mass to the neuroforamina, S3 resection through the ipsilateral neuroforamina, S4 resection through ipsilateral the spinal canal, and S5 and S6 contralateral sacral resections). Descriptive statistics and the chi-squared test were used for categorical variables, and the Kaplan-Meier survival analysis were performed. RESULTS: Resections were S1 in 25/151 patients (17%), S2 in 70/151 (46%), S3 in 33/151 (22%), S4 in 77/151 (11%), S5 in 4/151 (3%), and S6 in 2/151 (1%). An internal hemipelvectomy was performed in 113/151 patients (75%), and 38/151 patients (25%) had an external hemipelvectomy. The predominant types of sarcoma were high-grade osteosarcoma in 48/151 patients (32%), chondrosarcoma in 41/151 (27%), Ewing sarcoma in 33/151 (22%), pleomorphic sarcoma in 17/151 (11%), and others in 2/151 (8%). LR was found in 24/151 patients (15%) with S3, S5, with S6 resections showing the highest rate of LR (p = 0.038). Overall, 19/151 patients (16%) had evidence of metastastic disease at the time of surgery and these patients showed poorer survival when compared to patients with no metastasis. CONCLUSION: The proposed classification can help to report and compare different surgical and reconstructive approaches in these difficult cases who are still have a considerable risk of LR. Cite this article: Bone Joint J 2022;104-B(2):290-296.


Assuntos
Neoplasias Ósseas/cirurgia , Regras de Decisão Clínica , Hemipelvectomia/classificação , Ílio/cirurgia , Recidiva Local de Neoplasia/diagnóstico , Sacro/cirurgia , Sarcoma/cirurgia , Adulto , Idoso , Neoplasias Ósseas/mortalidade , Neoplasias Ósseas/patologia , Feminino , Seguimentos , Hemipelvectomia/métodos , Humanos , Ílio/patologia , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Metástase Neoplásica , Recidiva Local de Neoplasia/etiologia , Estudos Retrospectivos , Medição de Risco , Sacro/patologia , Sarcoma/mortalidade , Sarcoma/patologia , Resultado do Tratamento
14.
Bone Joint J ; 104-B(1): 142-149, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34969291

RESUMO

AIMS: The aim of this study was to assess whether it is possible to predict the mortality, and the extent and time of neurological recovery from the time of the onset of symptoms and MRI grade, in patients with the cerebral fat embolism syndrome (CFES). This has not previously been investigated. METHODS: The study included 34 patients who were diagnosed with CFES following trauma between 2012 and 2018. The clinical diagnosis was confirmed and the severity graded by MRI. We investigated the rate of mortality, the time and extent of neurological recovery, the time between the injury and the onset of symptoms, the clinical severity of the condition, and the MRI grade. All patients were male with a mean age of 29.7 years (18 to 70). The mean follow-up was 4.15 years (2 to 8), with neurological recovery being assessed by the Glasgow Outcome Scale and the Mini-Mental State Examination. RESULTS: In all, seven who had early-onset CFES (< 24 hours), and a severe Takahashi grade on MRI, died. There was a significant association between the time of onset of neurological signs and mortality (p = 0.035). Mortality was also significantly associated with a severe Takahashi grade (p < 0.001). Among the 27 surviving patients, 26 (96.3%) recovered completely. One (3.7%) had a cognitive deficit. The mean time to recovery was 4.7 weeks (2 to 13), with late recovery aftereight eight weeks being recorded in three patients. CONCLUSION: There was a significantly increased rate of mortality in patients with CFES who had an early onset of symptoms and a severe grade on MRI. Complete neurological recovery can be expected in most patients with CFES who survive. Cite this article: Bone Joint J 2022;104-B(1):142-149.


Assuntos
Embolia Gordurosa/diagnóstico por imagem , Embolia Gordurosa/mortalidade , Embolia Intracraniana/diagnóstico por imagem , Embolia Intracraniana/mortalidade , Imageamento por Ressonância Magnética , Testes de Estado Mental e Demência , Adolescente , Adulto , Idoso , Escala de Coma de Glasgow , Humanos , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Índice de Gravidade de Doença
15.
Bone Jt Open ; 2(12): 1017-1026, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34847700

RESUMO

AIMS: This study assessed the impact of COVID-19 on hip and distal femur fracture patient outcomes across three successive UK lockdown periods over one year. METHODS: A single-centre retrospective cohort study was performed at an acute NHS Trust. Hip and distal femur fracture patients admitted within the first month from each of the three starting dates of each national lockdown were included and compared to a control group in March 2019. Data were collected as per the best practice tariff outcomes including additional outcomes as required. Data collection included COVID-19 status, time to theatre, 30-day mortality, presence of acute kidney injury (AKI) and pneumonia, and do not attempt cardiopulmonary resuscitation (DNACPR) status. Data were analyzed using an independent-samples t-test or chi-squared test with Fisher's exact test where applicable. A p-value of < 0.05 was considered statistically significant. RESULTS: A total of 95 patients during the pandemic were included and 20 were COVID-positive. Patients experienced a statistically significant increase in time to theatre in Lockdown 1 compared to 2019 (p = 0.039) with a decrease with successive lockdown periods by Lockdown 3. The 30-day mortality increased from 8.8% in 2019 to 10.0% to 14.8% in all lockdown periods. COVID-positive patient mortality was 30.0% (p = 0.063, odds ratio (OR) = 4.43 vs 2019). The rates of AKI and pneumonia experienced were higher for patients during the pandemic. The highest rates were experienced in COVID-positive patients, with 45.0% of patients with AKI versus 27.0% in 2019 (p = 0.38, OR = 1.80), and 50.0% of patients diagnosed with pneumonia versus 16.2% in 2019 (p = 0.0012, OR = 5.17). The percentage of patients with a DNACPR increased from 30.0% in 2019 to 60.7% by Lockdown 3 (p = 0.034, OR = 3.61). CONCLUSION: COVID-positive hip and distal femur fracture patients are at a higher risk of mortality due to AKI and pneumonia. Patient outcomes have improved with successive lockdowns to pre-pandemic levels. Cite this article: Bone Jt Open 2021;2(12):1017-1026.

16.
Bone Joint J ; 103-B(12): 1815-1820, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34847712

RESUMO

AIMS: The aim of this study was to assess the prognostic value of the modified three-group Stulberg classification, which is based on the sphericity of the femoral head, in patients with Perthes' disease. METHODS: A total of 88 patients were followed from the time of diagnosis until a mean follow-up of 21 years. Anteroposterior pelvic and frog-leg lateral radiographs were obtained at diagnosis and at follow-up of one, five, and 21 years. At the five- and 21-year follow-up, the femoral heads were classified using a modified three-group Stulberg classification (round, ovoid, or flat femoral head). Further radiological endpoints at long-term follow-up were osteoarthritis (OA) of the hip and the requirement for total hip arthroplasty (THA). RESULTS: There were 71 males (81%) and 17 females. A total of 13 patients had bilateral Perthes' disease; thus 101 hips were analyzed. At five-year follow-up, 37 hips were round, 38 ovoid, and 26 flat. At that time, 66 hips (65%) were healed and 91 (90%) were skeletally immature. At long-term follow-up, when the mean age of the patients was 28 years (24 to 34), 20 hips had an unsatisfactory outcome (seven had OA and 13 had required THA). There was a strongly significant association between the modified Stulberg classification applied atfive-year follow-up and an unsatisfactory outcome at long-term follow-up (p < 0.001). Between the five- and 21-year follow-up, 67 hips (76%) stayed in their respective modified Stulberg group, indicating a strongly significant association between the Stulberg classifications at these follow-ups (p < 0.001). CONCLUSION: The modified Stulberg classification is a strong predictor of long-term radiological outcome in patients with Perthes' disease. It can be applied at the healing stage, which is usually reached five years after the diagnosis is made and before skeletal maturity. Cite this article: Bone Joint J 2021;103-B(12):1815-1820.


Assuntos
Doença de Legg-Calve-Perthes/classificação , Doença de Legg-Calve-Perthes/diagnóstico por imagem , Gravidade do Paciente , Adolescente , Adulto , Artroplastia de Quadril , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Doença de Legg-Calve-Perthes/complicações , Doença de Legg-Calve-Perthes/cirurgia , Masculino , Variações Dependentes do Observador , Osteoartrite do Quadril/etiologia , Osteoartrite do Quadril/cirurgia , Prognóstico , Estudos Prospectivos , Radiografia , Adulto Jovem
17.
Bone Joint Res ; 10(12): 790-796, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34894718

RESUMO

AIMS: To explore the effect of different durations of antibiotics after stage II reimplantation on the prognosis of two-stage revision for chronic periprosthetic joint infection (PJI). METHODS: This study involved a retrospective collection of patients who underwent two-stage revision for chronic PJI and continued to use extended antibiotic prophylaxis in two regional medical centres from January 2010 to June 2018. The patients were divided into a short (≤ one month) or a long (> one month) course of treatment based on the duration of antibiotics following stage II reimplantation. The difference in the infection control rate between the two groups was compared, and prognostic factors for recurrence were analyzed. RESULTS: A total of 105 patients with chronic PJI were enrolled: 64 patients in the short course group and 41 patients in the long course group. For 99 of the patients, the infection was under control during a follow-up period of at least 24 months after two-stage revision. For the short course group, the mean duration of antibiotic prophylaxis after stage II reimplantation was 20.17 days (SD 5.30) and the infection control rate was 95.3%; for the long course group these were 45.02 days (SD 15.03) and 92.7%, respectively. There was no significant difference in infection control rates between the two groups (p = 0.676). Cox regression analysis found that methicillin-resistant staphylococcus infection (p = 0.015) was an independent prognostic factor for recurrence. CONCLUSION: After stage II reimplantation surgery of two-stage revision for chronic PJI, extended antibiotic prophylaxis for less than one month can achieve good infection control rate. Cite this article: Bone Joint Res 2021;10(12):790-796.

18.
Bone Jt Open ; 2(10): 886-892, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34693724

RESUMO

AIMS: As the world continues to fight successive waves of COVID-19 variants, we have seen worldwide infections surpass 100 million. London, UK, has been severely affected throughout the pandemic, and the resulting impact on the NHS has been profound. The aim of this study is to evaluate the impact of COVID-19 on theatre productivity across London's four major trauma centres (MTCs), and to assess how the changes to normal protocols and working patterns impacted trauma theatre efficiency. METHODS: This was a collaborative study across London's MTCs. A two-month period was selected from 5 March to 5 May 2020. The same two-month period in 2019 was used to provide baseline data for comparison. Demographic information was collected, as well as surgical speciality, procedure, time to surgery, type of anaesthesia, and various time points throughout the patient journey to theatre. RESULTS: In total, 1,243 theatre visits were analyzed as part of the study. Of these, 834 patients presented in 2019 and 409 in 2020. Fewer open reduction and internal fixations were performed in 2020 (33.5% vs 38.2%), and there was an increase in the number of orthoplastic cases in 2020 (8.3% vs 2.2%), both statistically significant results (p < 0.000). There was a statistically significant increase in median time from 2019 to 2020, between sending for a patient and their arrival to the anaesthetic room (29 vs 35 minutes; p = 0.000). Median time between arrival in the anaesthetic room and commencement of anaesthetic increased (7 to 9 minutes; p = 0.104). CONCLUSION: Changes in working practices necessitated by COVID-19 led to modest delays to all aspects of theatre use, and consequently theatre efficiency. However, the reality is that the major concerns of impact of service did not occur to the levels that were expected. Cite this article: Bone Jt Open 2021;2(10):886-892.

19.
BMC Med Res Methodol ; 21(1): 224, 2021 10 25.
Artigo em Inglês | MEDLINE | ID: mdl-34689743

RESUMO

BACKGROUND: Network meta-analysis (NMA) has attracted growing interest in evidence-based medicine. Consistency between different sources of evidence is fundamental to the reliability of the NMA results. The purpose of the present study was to estimate the prevalence of evidence of inconsistency and describe its association with different NMA characteristics. METHODS: We updated our collection of NMAs with articles published up to July 2018. We included networks with randomised clinical trials, at least four treatment nodes, at least one closed loop, a dichotomous primary outcome, and available arm-level data. We assessed consistency using the design-by-treatment interaction (DBT) model and testing all the inconsistency parameters globally through the Wald-type chi-squared test statistic. We estimated the prevalence of evidence of inconsistency and its association with different network characteristics (e.g., number of studies, interventions, intervention comparisons, loops). We evaluated the influence of the network characteristics on the DBT p-value via a multivariable regression analysis and the estimated Pearson correlation coefficients. We also evaluated heterogeneity in NMA (consistency) and DBT (inconsistency) random-effects models. RESULTS: We included 201 published NMAs. The p-value of the design-by-treatment interaction (DBT) model was lower than 0.05 in 14% of the networks and lower than 0.10 in 20% of the networks. Networks including many studies and comparing few interventions were more likely to have small DBT p-values (less than 0.10), which is probably because they yielded more precise estimates and power to detect differences between designs was higher. In the presence of inconsistency (DBT p-value lower than 0.10), the consistency model displayed higher heterogeneity than the DBT model. CONCLUSIONS: Our findings show that inconsistency was more frequent than what would be expected by chance, suggesting that researchers should devote more resources to exploring how to mitigate inconsistency. The results of this study highlight the need to develop strategies to detect inconsistency (because of the relatively high prevalence of evidence of inconsistency in published networks), and particularly in cases where the existing tests have low power.


Assuntos
Reprodutibilidade dos Testes , Humanos , Metanálise em Rede , Prevalência , Análise de Regressão
20.
Bone Joint J ; 103-B(9): 1488-1496, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34465149

RESUMO

AIMS: The current study aimed to compare robotic arm-assisted (RA-THA), computer-assisted (CA-THA), and manual (M-THA) total hip arthroplasty regarding in-hospital metrics including length of stay (LOS), discharge disposition, in-hospital complications, and cost of RA-THA versus M-THA and CA-THA versus M-THA, as well as trends in use and uptake over a ten-year period, and future projections of uptake and use of RA-THA and CA-THA. METHODS: The National Inpatient Sample was queried for primary THAs (2008 to 2017) which were categorized into RA-THA, CA-THA, and M-THA. Past and projected use, demographic characteristics distribution, income, type of insurance, location, and healthcare setting were compared among the three cohorts. In-hospital complications, LOS, discharge disposition, and in-hospital costs were compared between propensity score-matched cohorts of M-THA versus RA-THA and M-THA versus CA-THA to adjust for baseline characteristics and comorbidities. RESULTS: RA-THA and CA-THA did not exhibit any clinically meaningful reduction in mean LOS (RA-THA 2.2 days (SD 1.4) vs 2.3 days (SD 1.8); p < 0.001, and CA-THA 2.5 days (SD 1.9) vs 2.7 days (SD 2.3); p < 0.001, respectively) compared to their respective propensity score-matched M-THA cohorts. RA-THA, but not CA-THA, had similar non-home discharge rates to M-THA (RA-THA 17.4% vs 18.5%; p = 0.205, and 18.7% vs 24.9%; p < 0.001, respectively). Implant-related mechanical complications were lower in RA-THA (RA-THA 0.5% vs M-THA 3.1%; p < 0.001, and CA-THA 1.2% vs M-THA 2.2%; p < 0.001), which was associated with a significantly lower in-hospital dislocation (RA-THA 0.1% vs M-THA 0.8%; p < 0.001). Both RA-THA and CA-THA demonstrated higher mean higher index in-hospital costs (RA-THA $18,416 (SD $8,048) vs M-THA $17,266 (SD $8,396); p < 0.001, and CA-THA $20,295 (SD $8,975) vs M-THA $18,624 (SD $9,226); p < 0.001, respectively). Projections indicate that 23.9% and 3.2% of all THAs conducted in 2025 will be robotic arm- and computer-assisted, respectively. Projections indicated that RA-THA use may overtake M-THA by 2028 (48.3%) and reach 65.8% of all THAs by 2030. CONCLUSION: Technology-assisted THA, particularly RA-THA, may provide value by lowering in-hospital early dislocation rates and and other in-hospital metrics compared to M-THA. Higher index-procedure and hospital costs warrant further comprehensive cost analyses to determine the true added value of RA-THA in the episode of care, particularly since we project that one in four THAs in 2025 and two in three THA by 2030 will use RA-THA technology. Cite this article: Bone Joint J 2021;103-B(9):1488-1496.


Assuntos
Procedimentos Cirúrgicos Robóticos , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/métodos , Bases de Dados Factuais , Feminino , Previsões , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Cirurgia Assistida por Computador , Estados Unidos/epidemiologia
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