Efficacy and Postoperative Complication Rates of Different Surgical Approaches for Calcaneal Fractures: A Network Meta-analysis.

Context: Calcaneal fractures (CFs) are the most common kind of tarsal fracture. The choice of surgical approach is a key element in the management of CFs, but the best method remains in dispute. Also, no single approach is appropriate for all kinds of CFs. Objective: The study intended to evaluate the relationship between six surgical approaches for clinical treatment of CFs and prevention of postoperative complications, to provide an evidence-based approach for treatment. Design: The research team performed a meta-analysis using the data from a previously published review and updating that data through a new narrative review. The team performed a systematic search in PubMed, Embase, the Cochrane Library, and the Chinese National Knowledge Internet (CNKI) from inception until January 2022, with no language restrictions. The search used the following keywords for the search: calcaneus, heel bone, surgical wounds, surgical incisions, prospective trials, prospective trials, and randomized controlled trials. Outcome Measures: The research team compared the complication rates, American Orthopedic Foot and Ankle Society (AOFAS) scores, and Bohler's angles for the six surgical approaches, which were: (1) the extensive lateral approach (ELA), (2) the sinus tarsi approach (STA), (3) the horizontal arc approach (HAA), (4) the longitudinal approach (LA), (5) the oblique lateral incision (OLI), and (6) the modified incision (MI)). The team summarized the results using a random effects model. Results: The research team analyzed the data from 19 RCTs with 1521 participants. They all were randomized controlled trials (RCTs). The complication rates were available for 18 studies, which included 1474 participants. The rates were significantly lower: (1) for HAA compared to ELA, [OR=-2.03; 95% CrI: [-3.63, -0.43)]; (2) for LA compared to ELA (OR=-1.83; 95% CrI: [-2.83, -0.84]); and (3) for STA compared to ELA (OR=- 1.22; 95% CrI: [-1.67, -0.78]). Of the 19 studies, 11 RCTs, with 942 participants, used the AOFAS scale. The probabilities for the surface under the cumulative ranking curve (SUCRA) indicated that OLI (0.694 ) >LA (0.596) >HAA (0.51) >STA (0.477) >ELA (0.224). In addition, ELA had the worst SUCRA (0.224). Of the 19 studies, 15 RCTs, with 1376 participants, used the Bohler angle as an outcome measure. The probability of SUCRA for the surgical approaches indicated that LA (0.723) >ELA (0.667) >STA (0.468) >HAA (0.373) >MI (0.27). Conclusions: The meta-analysis provides an evidence-based approach to the clinical treatment of CFs for six surgical approaches. HAA had the best outcomes, and ELA had the worst.

Concurrent use of corticosteroids with licorice-containing TCM preparations in Taiwan: a National Health Insurance Database study.

OBJECTIVES: This study used a nationwide population-based dataset from the 1997-2003 National Health Insurance claims to explore the prevalence, frequency, and relative risk of concurrent use of systemic corticosteroids with licorice-containing Traditional Chinese Medicine (TCM) preparations that might possibly result in drug-herb interactions. DESIGN: This study was based on the complete datasets of Western medicine and TCM outpatient reimbursement claims from 1997 to 2003 contained in the National Health Insurance Research Database of Taiwan. According to the date and duration of prescriptions, the patients who concurrently used systemic corticosteroids with licorice-containing TCM preparations were derived for statistical analysis. SETTING: This study was set in Taiwan. OUTCOME MEASURES: Descriptive statistics were used to analyze the demographics of patients who used corticosteroids with licorice-containing TCM preparations concurrently, including age, gender, and the frequency and percentage of major diseases in International Classification of Diseases, 9th version, Clinical Modification (ICD-9-CM) categories. The relative risk of potential corticosteroid-herb interaction was also analyzed with respect to different characteristics of the patients (age, sexuality etc.). RESULTS: The prevalence of concurrent use of systemic corticosteroids with licorice-containing TCM preparations through prescriptions from different Chinese medicine and Western medicine physicians was 1.495%. Among the major disease categories, ICD-9-CM codes 280-289 had the highest prevalence rate of 3.803%. CONCLUSIONS: Potential risk of corticosteroid-licorice interactions may happen, even through formal medical services. In the future, such educational propagations should be reinforced. Furthermore, an alert device that includes well-recognized drug-herb interactions should be built into every hospital's computer system to remind physicians to be cautious on drug safety.

Factors influencing the purchasing behavior of TCM outpatients in Taiwan.

OBJECTIVES: To test the factors that influence Chinese medicine outpatients' behavior patterns in purchasing Traditional Chinese Medicine (TCM) under the National Health Insurance (NHI) system in Taiwan. METHODS: A structural questionnaire was developed and administered to randomly selected outpatients waiting for Chinese Medicine at pharmacies in two academic hospitals that offered Chinese Medicine services in central Taiwan. A total of 641 effective questionnaires were collected. SPSS 10.0 (Statistical Package for Social Sciences, SPSS Inc., Chicago, IL) was used to run descriptive analysis and one-way analysis of variance (ANOVA). In addition, LISREL 8.30 (Analytical Package, Scientific Software International, Inc., Chicago, IL) was used to modify and analyze the relationship between the variables of the hypothetical pathway model. RESULTS: Path analysis showed that "behavioral intention" and "suffering from disease" had positive and direct influences on the outpatients' patterns of purchasing TCM. Furthermore, "usable resources" was an important factor with direct influence on behavioral intention. When there were more usable resources, the behavioral intention became stronger and indirectly influenced the purchasing behavior of TCM outpatients. In addition, one-way ANOVA showed that the purchasing behavior was significantly influenced by the number of diseases that an individual suffered. The results of the pathway model showed that "behavioral intention" and "suffering from disease" had positive and direct influence on the TCM purchasing behavior of Chinese Medicine outpatients. However, "usable resources" was an important factor with direct influence on behavioral intention. When there were more usable resources, the behavioral intention became stronger and indirectly had influence on the TCM purchasing behavior. Furthermore, the analysis result of one-way ANOVA showed that the more chronic diseases the surveyed subject suffered, the more significant the influence on purchasing behavior became. CONCLUSIONS: Under the current NHI system, patients with multiple chronic diseases are the major purchasers of TCM products not covered by NHI. Therefore, increasing the usable resources of TCM products for the patients with chronic diseases will help hospitals in developing TCM services under the current NHI system.