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2.
Medicina (Kaunas) ; 55(7)2019 Jul 07.
Artigo em Inglês | MEDLINE | ID: mdl-31284666

RESUMO

Background and objectives: Lumbar spine surgery may be considered if pharmacologic, rehabilitation and interventional approaches cannot provide sufficient recovery from low back-related pain. Postoperative physiotherapy treatment in England is often accompanied by patient information leaflets, which contain important rehabilitation advice. However, in order to be an effective instrument for patients, the information provided in these leaflets must be up to date and based on the best available evidence and clinical practice. This study aims to critically analyse the current postoperative aspects of rehabilitation (exercise prescription and return to normal activity) that are provided in patient information leaflets in England as part of an evaluation of current practice following lumbar spine surgery. Materials and Methods: Patient information leaflets from English National Health Service (NHS) hospitals performing lumbar spine surgery were sourced online. A content analysis was conducted to collect data on postoperative exercise prescription and return to normal activities. Results: Thirty-two patient information leaflets on lumbar surgery were sourced (fusion, n = 11; decompression, n = 15; all lumbar procedures, n = 6). Many of the exercises prescribed within the leaflets were not based on evidence of clinical best practice and lacked a relationship to functional activity. Return to normal activity advice was also wide ranging, with considerable variation in the recommendations and definitions provided. Conclusions: This study highlights a clear variation in the recommendations of exercise prescription, dosage and returning to normal activities following lumbar spine surgery. Future work should focus on providing a consistent and patient-centred approach to recovery.


Assuntos
Terapia por Exercício/estatística & dados numéricos , Vértebras Lombares/cirurgia , Procedimentos Ortopédicos/normas , Educação de Pacientes como Assunto/normas , Volta ao Esporte/estatística & dados numéricos , Inglaterra , Exercício/fisiologia , Terapia por Exercício/métodos , Humanos , Dor Lombar/complicações , Dor Lombar/cirurgia , Vértebras Lombares/lesões , Procedimentos Ortopédicos/métodos , Procedimentos Ortopédicos/estatística & dados numéricos , Folhetos , Educação de Pacientes como Assunto/métodos , Período Pós-Operatório , Pesquisa Qualitativa , Medicina Estatal/organização & administração , Medicina Estatal/estatística & dados numéricos
3.
Medicina (Kaunas) ; 55(6)2019 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-31181706

RESUMO

Objectives: This review investigated the effects of orthodontic or functional orthopedic therapy on masseter muscle thickness through the use of ultrasonography (US) in growing subjects when compared with untreated subjects. Materials and Methods: This review systematically assessed studies that investigated growing subjects undergoing orthopedic therapy for the correction of malocclusion of vertical, sagittal and transversal plane. Electronic databases (CENTRAL, MEDLINE-PubMed, Scopus and Web of Science) were searched up to February 2019, including available RCTs and CCTs, without language restrictions. The primary outcome was the effect of orthopedic or functional treatment on masseter muscle thickness. The risk of bias of included studies was assessed through the Newcastle-Ottawa quality assessment scale with the aim of defining their methodological quality. A random-effects meta-analysis analyzing mean differences with 95% confidence intervals was used for quantitative analysis. Results: The search retrieved 749 titles, but the studies selection resulted in a final sample of 5 CCTs. The studies retrieved data from 233 children (age range: 5-22 years) and were conducted at university dental clinics. Children were treated for Class II malocclusion, increased vertical dimension or lateral cross-bite variably with rapid or slow maxillary expansion, twin block, bite block, mandibular activators, quad helix, alone or in combination. Risk of bias was assessed as medium for three studies, low for one and high for another. The meta-analysis determined that at the end of orthopedic or functional treatment masseter muscle thickness, measured through the use of US, is significantly reduced (MD -0.79 mm; 95% CI -1.28 to -0.31). The reduction in muscle thickness, therefore, could be considered an indicator for the evaluation of the success of therapy with orthodontic appliances. Conclusions: Although the meta-analysis revealed that US could be considered a less invasive and effective method to evaluate the masseter muscle thickness, single-blinded RCTs, are required to confirm US reliability in this field of application. This review was registered on PROSPERO with the following registration number: CRD42018068402.


Assuntos
Músculo Masseter/anormalidades , Ortodontia Corretiva/normas , Ultrassonografia/métodos , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Mandíbula/anormalidades , Músculo Masseter/fisiopatologia , Ortodontia Corretiva/métodos , Procedimentos Ortopédicos/métodos , Procedimentos Ortopédicos/normas , Adulto Jovem
4.
Neurology ; 93(2): e149-e158, 2019 07 09.
Artigo em Inglês | MEDLINE | ID: mdl-31164393

RESUMO

OBJECTIVE: To investigate the natural course of scoliosis and to estimate lifetime probability of scoliosis surgery in spinal muscular atrophy (SMA). METHODS: We analyzed cross-sectional data from 283 patients from our population-based cohort study. Additional longitudinal data on scoliosis progression and spinal surgery were collected from 36 consecutive patients who received scoliosis surgery at our center. RESULTS: The lifetime probability of receiving scoliosis surgery was ≈80% in SMA types 1c and 2. Patients with type 2 who only learned to sit (type 2a) were significantly younger at time of surgery than those who learned to sit and stand (type 2b). The lifetime risk of surgery was lower in type 3a (40%) and strongly associated with age at loss of ambulation: 71% in patients losing ambulation before 10 years of age vs 22% losing ambulation after the age of 10 years (p = 0.005). In type 3a, preserving the ability to walk 1 year longer corresponded to a 15% decrease in lifetime risk of scoliosis surgery (hazard ratio 0.852, p = 0.017). Scoliosis development was characterized by initial slow progression, followed by acceleration in the 1.5- to 2-year period before surgery. CONCLUSION: The lifetime probability of scoliosis surgery is high in SMA types 1c and 2 and depends on age at loss of ambulation in type 3. Motor milestones such as standing that are not part of the standard classification system are of additional predictive value. Our data may act as a reference to assess long-term effects of new SMA-specific therapies.


Assuntos
Atrofia Muscular Espinal/fisiopatologia , Escoliose/fisiopatologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Estudos de Coortes , Estudos Transversais , Progressão da Doença , Feminino , Humanos , Lactente , Recém-Nascido , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Atrofia Muscular Espinal/complicações , Procedimentos Ortopédicos/normas , Escoliose/etiologia , Escoliose/cirurgia , Adulto Jovem
5.
Semin Pediatr Surg ; 28(3): 172-177, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31171153

RESUMO

In 1998, Donald Nuss changed the way the world thought about the surgical repair of pectus excavatum. The new operation adheres to sound orthopedic fundaments, but has a significantly higher learning curve than other operations in pediatric surgery. Variations in pectus excavatum type, severity, symmetry and chest wall pliability bring challenges. This article will detail common error traps and ways to avoid them when performing the Nuss procedure. As recent publications have shown, an operation done more than 50,000 times across the world may bring to light infrequent but devastating outcomes that may be preventable. The critical view of safety for pectus repair is discussed, as are areas where a culture of safety could optimize results on a larger scale. We will review potential opportunities to improve outcomes by identifying error traps in the preoperative, intraoperative, and postoperative care of patients undergoing the Nuss procedure.


Assuntos
Tórax em Funil/cirurgia , Complicações Intraoperatórias/terapia , Erros Médicos , Procedimentos Ortopédicos/normas , Segurança do Paciente/normas , Complicações Pós-Operatórias/terapia , Adolescente , Animais , Criança , Pré-Escolar , Tórax em Funil/diagnóstico , Humanos , Complicações Intraoperatórias/etiologia , Procedimentos Ortopédicos/efeitos adversos , Procedimentos Ortopédicos/métodos , Complicações Pós-Operatórias/etiologia
6.
Medicina (Kaunas) ; 55(6)2019 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-31185694

RESUMO

Background and objectives: Pediatric tibial shaft fractures often have satisfactory outcomes after closed reduction and casting. However, surgical treatment may be required in unstable or open fractures. Titanium elastic nails (TENs) are a good option for the surgical treatment of pediatric tibial fractures due to their advantages such as short hospitalization periods, easy applicability, early weight bearing, and early union. In this study, we evaluated radiological and functional outcomes in pediatric patients with tibial shaft fractures that underwent fixation with TENs. Materials and methods: A total of twenty tibial shaft fractures that were treated with TENs in our clinic between 2013 and 2017 were retrospectively reviewed. The mean age at injury was 8.9 ± 2.78 (range of 3-14) years. Seven (35%) out of 20 fractures were open fractures, of which one fracture was classified as Grade I and six fractures were classified as Grade II. In each patient, antegrade nailing was performed by inserting a TEN in the medial and another TEN in the lateral side of the proximal metaphysis. Clinical outcomes including union, alignment, leg-length inequality, and complications were evaluated using modified Flynn's criteria. Results: The mean time to union was 10.85 ± 3.39 (range of 6-20) weeks. No patient had a sagittal or coronal angulation of over 10°. One patient had a leg-length inequality of 10 mm. Among three patients with open fractures, two of them had superficial wound infections and the other patient had a deep wound infection. All the infections were successfully treated with appropriate antibiotic therapies. Four other patients had pin tract irritation that required no intervention. No significant difference was observed between patients with open and closed fractures with regard to the clinical and radiological findings although patients with open fractures had a significantly higher complication rate compared to patients with closed fractures (p < 0.05). No patient had a restricted range of motion of the ankle and knee joints. Twelve (60%) patients had an excellent outcome, and eight (40%) patients had a satisfactory outcome. Conclusions: Intramedullary fixation with TENs provides favorable outcomes and reduced complication rates in the treatment of unstable pediatric tibial shaft fractures that cannot be reduced with conservative treatment modalities or cannot be casted due to the presence of an edema or open wound.


Assuntos
Pinos Ortopédicos/normas , Fraturas da Tíbia/cirurgia , Adolescente , Pinos Ortopédicos/estatística & dados numéricos , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Procedimentos Ortopédicos/métodos , Procedimentos Ortopédicos/normas , Radiografia/métodos , Estudos Retrospectivos , Tíbia/lesões , Tíbia/cirurgia , Titânio/uso terapêutico , Resultado do Tratamento
7.
J Am Acad Orthop Surg ; 27(13): e589-e595, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31232793

RESUMO

While health care evolves from volume to value, there is increasing interest by payors to use patient-reported outcomes (PROs) to determine value and more specifically, quality from the patient's perspective. This article reviews the current state of PROs and discusses future directions. Specifically, this article will review the current history and background of PROs; it will highlight the perspective of the National Quality Forum and review the efforts of the musculoskeletal community related to PROs. Goals, positive aspects, limitations, and barriers related to PROs will be discussed. Additionally, development considerations and strategies will be highlighted. Finally, development recommendations from the American Academy of Orthopaedic Surgery position statement "principles for musculoskeletal based PRO performance measurement development" will be introduced.


Assuntos
Avaliação da Deficiência , Doenças Musculoesqueléticas/cirurgia , Procedimentos Ortopédicos/normas , Medidas de Resultados Relatados pelo Paciente , Humanos
9.
Orthop Nurs ; 38(3): 193-198, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31124870

RESUMO

BACKGROUND: Osteoarthritis (OA) is a degenerative disease causing decreased mobility. Use of autologous platelet-rich plasma (PRP) provides a reparative alternative in the management of OA. METHODS/PURPOSE: This study assessed effectiveness of nurse practitioner-injected PRP to manage knee OA in a rural setting. RESULTS: Twenty patients were followed for 1 month after PRP treatment. Knee function and pain levels were assessed using a knee function score (Knee Injury and Osteoarthritis Outcome Score Physical Function Short Form [KOOS-PS]). CONCLUSIONS: Overall, the 20 patients who participated in this study experienced significant improvement in knee function scores, decreased pain, and decreased use of pain medications.


Assuntos
Procedimentos Ortopédicos/normas , Osteoartrite do Joelho/terapia , Plasma Rico em Plaquetas , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos/métodos , Procedimentos Ortopédicos/tendências , Osteoartrite do Joelho/fisiopatologia , Dor/tratamento farmacológico , Medição da Dor/métodos , População Rural , Resultado do Tratamento
10.
Cir Cir ; 87(3): 299-307, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31135780

RESUMO

Introduction: The spine surgeon has knowledge and skills that allow him to make decisions when performing a surgical procedure, based on the evidence and ethical values and expectations of the patient. Any surgical procedure will be preceded by a diagnosis based on four fundamental pillars: traumatic, degenerative, vertebral destruction syndrome and deformities. Once the lesion is categorized, the surgeon will use his knowledge to identify instability or neurological compromise. When performing a surgical procedure, it should be kept in mind in the transoperative the four key objectives that will count, to achieve a satisfactory management: decompress, implement, merge and correct the sagittal balance. Objective: To analyze the fundamental criteria in decision making, for conservative or surgical management in the spine. Results: The assessment scales and the most frequent and best practices in relation to spine surgery will be analyzed, as well as the applications that will be applied and evaluated in each particular case, which will strengthen the diagnostic impression and the value forecast. Conclusion: Implementing the culture of using patient outcome measurements as an assessment tool helps the spine surgeon to decide on a treatment plan that can be adapted to the patient's preferences and needs. We must base our clinical objective on the stability and the neurological commitment of the patient, there being four diagnostic possibilities; which will be corrected for four fundamental objectives.


Assuntos
Tomada de Decisão Clínica , Procedimentos Ortopédicos/normas , Coluna Vertebral/cirurgia , Humanos , Guias de Prática Clínica como Assunto
11.
Bull Hosp Jt Dis (2013) ; 77(2): 122-127, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31128581

RESUMO

OBJECTIVE: An important part of clinical training is learning how to identify and prevent hospital-acquired conditions or injuries. Despite this, there are few standardized methods in graduate medical education (GME) for teaching and assessing resident patient safety skills. Residents often do not report safety events, and increasing resident engagement can positively impact patient safety. In the current study, we sought to apply such a tool in gauging the capacity of orthopedic surgery interns at a large academic medical center to identify patient safety hazards and begin a discussion regarding the management of potential patient safety issues. METHODS: A total of 27 orthopedic surgery interns at a single large academic medical center participated in the current observational study divided into two distinct groups in the summers of 2016 and 2017. A patient room was simulated with a training mannequin lying supine in a hospital bed. A mock patient chart and handoff were created in the electronic medical record (EMR) on the bedside computer. Patient safety hazards and errors of care were placed around the room and in the EMR, including several derived from the Joint Commission's National Patient Safety Goals. Each intern was given a maximum of 20 minutes to identify as many of the simulated patient safety hazards as possible. A debrief was conducted at the end of the exercise to discuss their responsibility to speak up when hazards are identified in a non-simulated patient room. For analysis, the hazards were distributed into four categories: room organization, EMR, patient care, and white board. Each intern's individual score (number of complete identifications/total number of hazards) and the group's performance as a whole in each category were calculated. RESULTS: The mean individual score was 51.54% (26.67% to 70.00%) in group A and 40.41% (25.71% to 54.29%) in group B. In group A, room organization hazards were identified more than any other category (74.62%), followed by patient care errors (40.38%), EMR hazards (40.17%), and white board errors (38.46%). In group B, room organization was identified the most (57.74%), followed by EMR (50%), and patient care and white board hazards (28.57% each). Certain critical safety hazards were identified by a small number of interns. For example, the inadequate handoff was only identified by four interns in each group. CONCLUSIONS: Hazards related to room cleanliness were easier to identify than hazards related to specific errors in patient care. A wide variation in the identification of critical safety issues was observed among the trainees assessed. This type of simulated educational experience provides important opportunities for resident-specific education in the realm of patient safety and health care quality.


Assuntos
Competência Clínica , Internato e Residência/métodos , Procedimentos Ortopédicos , Assistência ao Paciente , Segurança do Paciente , Centros Médicos Acadêmicos/métodos , Currículo , Educação , Avaliação Educacional , Humanos , Manequins , Procedimentos Ortopédicos/educação , Procedimentos Ortopédicos/métodos , Procedimentos Ortopédicos/normas , Assistência ao Paciente/efeitos adversos , Quartos de Pacientes/normas , Treinamento por Simulação/métodos
12.
Orthop Surg ; 11(2): 153-159, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31025807

RESUMO

The pedicle screw placement procedure is the most commonly used technique for spinal fixation and can provide reliable three-column stabilization. Accurate screw placement is necessary in clinical practice. To avoid screw malposition, which may decrease the stiffness of the screw-rod construct or increase the likelihood of neural and vascular injuries, the surgeons must fully understand the regional anatomy. Deformities, such as scoliosis, kyphosis or congenital anomalies, may complicate the application of the pedicle screw placement technique and increase the chance of screw encroachments. Incidences of pedicle screw malposition vary in different districts and hospitals and with surgeons and techniques. Today, the minimally invasive spinal surgery is well developed. However, the narrow corridors and limited views for surgeons increase the difficulty of pedicle screw placement and the possibility of screw encroachment. Evidenced by previous studies, robotic surgery can provide accurate screw placement, especially in settings of spinal deformities, anatomical anomalies, and minimally invasive procedures. Based on the consensus of consultant specialists, the literature review and our local experiences, this guideline introduces the robotic system and describes the workflow of robot-assisted procedures and the precautions to take during procedures. This guideline aims to outline a standardized method for robotic surgery for thoracolumbar pedicle screw placement.


Assuntos
Vértebras Lombares/cirurgia , Procedimentos Ortopédicos/normas , Parafusos Pediculares/normas , Procedimentos Cirúrgicos Robóticos/normas , Vértebras Torácicas/cirurgia , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos/normas , Procedimentos Ortopédicos/instrumentação , Procedimentos Ortopédicos/métodos , Procedimentos Cirúrgicos Robóticos/instrumentação , Procedimentos Cirúrgicos Robóticos/métodos , Cirurgia Assistida por Computador/normas
13.
Orthop Surg ; 11(2): 160-166, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31025810

RESUMO

Atlantoaxial transarticular facet screw fixation (Magerl technique) and C1 lateral mass screws combined with C2 pedicle screws fixation (Harms technique) are the most commonly used techniques for posterior internal fixation in the upper cervical spine. Upper cervical spinal surgery is a technically demanding and challenging procedure because of complicated anatomical structures and frequent occurrence of anomalies. Accurate insertion of screws allows for stable and secure internal fixation, which is necessary for both techniques. Traditional methods under fluoroscopic assistance in this region cannot meet the requirements of high levels of accuracy and security during the procedure. Robot-assisted spinal surgery can provide accurate and reliable guidance during the screw insertion, which is evidenced in the literature. As a recently developed technique, robot-assisted surgery is supposed to be performed by skilled surgeons who have received standard training for robotic surgery. The standardized upper cervical spinal surgery assisted by the robot system needs to be introduced to these surgeons. Based on the consensus of consultant specialists, the literature review, and our local experience, this guideline included the introduction of the robotic system, the workflow of robot-assisted procedures, and the precautions to take during procedures. This guideline aims to provide a standardization of the robotic surgery for posterior atlantoaxial internal fixation.


Assuntos
Vértebra Cervical Áxis/cirurgia , Atlas Cervical/cirurgia , Procedimentos Ortopédicos/normas , Procedimentos Cirúrgicos Robóticos/normas , Parafusos Ósseos/normas , Humanos , Procedimentos Ortopédicos/instrumentação , Procedimentos Ortopédicos/métodos , Procedimentos Cirúrgicos Robóticos/instrumentação , Procedimentos Cirúrgicos Robóticos/métodos , Cirurgia Assistida por Computador/normas
15.
J Bone Joint Surg Am ; 101(5): e18, 2019 Mar 06.
Artigo em Inglês | MEDLINE | ID: mdl-30845044

RESUMO

BACKGROUND: Evaluation of surgical skill competency is necessary as graduate medical education moves toward a competency-based curriculum. This study by the American Board of Orthopaedic Surgery (ABOS) and the Council of Orthopaedic Residency Directors (CORD) compares 2 web-based evaluation tools that assess the level of autonomy that is demonstrated by residents during surgical procedures in the operating room as measured by faculty. METHODS: Two hundred and ninety-four residents from 16 orthopaedic surgery residency programs were evaluated by 370 faculty using 2 web-based evaluation tools in a crossover design in which residents requested faculty review of their surgical skills before starting a case. One thousand, one hundred and fifty Ottawa Surgical Competency Operating Room Evaluation (O-Score) assessments, which included a 9-question evaluation of 8 steps of the surgical procedure, were compared with 1,186 P-score evaluations, which included a single-question summative evaluation. Twenty-five different surgical procedures were evaluated. RESULTS: There were no significant differences in rates of resident requests or faculty completion of the 2 scores. The most common surgical procedures that were assessed were total knee arthroplasty (n = 254, 11%), carpal tunnel release (n = 191, 8%), open reduction and internal fixation (ORIF) of stable hip fractures (n = 170, 7%), ORIF of simple ankle fractures (n = 169, 7%), and total hip arthroplasty (n = 166, 7%). Both instruments disclosed significant differences in competency among entry, intermediate, and advanced-level residents. The findings support the construct validity of the evaluation method. The survey results indicated that >70% of the faculty were confident that use of either the P-score or the O-score allowed them to distinguish a resident who can perform the surgery independently from one who needs additional training. CONCLUSIONS: This research has led to the modification of the O-score and the P-score into a combined OP-score instrument. The ABOS envisions that the OP-score instrument can be used with an expanded number of surgical procedures as a required element of residency training in the near future. CLINICAL RELEVANCE: This study allows the profession of orthopaedic surgery education to take a leadership role in the measurement of competence for surgical skills for orthopaedic surgeons in residency training, an important clinically relevant topic to the practice of orthopaedic surgery.


Assuntos
Competência Clínica/normas , Internato e Residência/normas , Procedimentos Ortopédicos/normas , Ortopedia/educação , Análise de Variância , Educação Baseada em Competências/métodos , Estudos de Viabilidade , Humanos , Internet , Internato e Residência/métodos , Ortopedia/normas , Estados Unidos
16.
Fa Yi Xue Za Zhi ; 35(1): 52-57, 2019 Feb.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-30896120

RESUMO

OBJECTIVES: To analyze the characteristics of medical malpractices in orthopaedic surgeries, to explore principles and methods in medical legal identification, and to provide basic data for uniform medicolegal standard for the future medical identification. METHODS: A retrospective analysis was conducted on 100 cases of medical malpractices in orthopaedic surgery, among the 364 cases archived in Medicolegal Expertise Center of Xi'an Jiaotong University during 2002-2015. RESULTS: In the 100 cases of orthopedic medical malpractices, with 104 hospitals involved in, 95 cases were judged with medical errors and the other 9 cases with no error. The top 3 reasons for errors were (1) inadequate observation or estimation of diseases (27.9%), (2) intraoperative improper operation (17.3%), and (3) delayed or missed diagnosis and treatment (12.5%). The consequences of medical malpractices were mostly disability (61%), followed by prolonged diseases (31%) and death (8%). With regard to the causal relationship between medical errors and consequences, 95 cases (91.4%) were with causality and the other 9 cases (8.6%) with no causality. Specifically, 56 cases (53.9%) were with medical errors as the secondary causes accounting for 25% causative potency, and 20 cases (19.2%) were with medical errors as the major causes accounting for 75% causative potency. CONCLUSIONS: It is pivotally important for determining the causative potency of medical errors to analyse the causes of damages in orthopaedic surgery and to distinguish subjective factors from objective ones of medical errors.


Assuntos
Imperícia , Procedimentos Ortopédicos , Ortopedia , Humanos , Erros Médicos , Procedimentos Ortopédicos/efeitos adversos , Procedimentos Ortopédicos/normas , Estudos Retrospectivos
17.
J Bone Joint Surg Am ; 101(3): e10, 2019 Feb 06.
Artigo em Inglês | MEDLINE | ID: mdl-30730490

RESUMO

BACKGROUND: Education in microvascular surgery is limited by variable experience, a difficult learning curve, and potentially catastrophic complications caused by failed anastomoses. Furthermore, utilization of live-animal training models can be difficult because of lack of access and high maintenance costs. The purpose of this study was to determine the effectiveness and cost of a self-directed microvascular training curriculum utilizing synthetic microvessels and nonliving models in an orthopaedic residency program. METHODS: Twenty-five orthopaedic residents ranging from postgraduate year (PGY)-1 to PGY-4 were prospectively enrolled. The curriculum consisted of learning the basics of microsurgery on nonliving models and progressed to anastomoses on a 1-mm synthetic microvessel. Outcomes included Global Rating Scale (GRS) scores (5 to 25 points), patency, anastomosis time, comfort level (1 to 10 points), time to complete the curriculum, and curriculum utility (1 to 10 points). Blinded qualitative assessments (from 1 to 10 points) of pre-curriculum and post-curriculum anastomoses were made by 4 hand surgery faculty members. Outcome measures were obtained at baseline and post-curriculum. The curriculum cost was calculated as the setup cost and the maintenance cost per resident. Student t tests and Fisher exact tests were utilized for significance. RESULTS: All residents successfully completed the curriculum. The mean anastomosis time (and standard deviation) decreased from 40 ± 3 minutes to 22 ± 4 minutes (p < 0.001). The mean GRS score improved from 12 ± 2 points to 18 ± 2 points (p < 0.01). Patency was achieved by 44% at baseline evaluation and by 96% at post-curriculum evaluation (p < 0.0001). The mean comfort level improved from 3 ± 1.2 points to 6 ± 1.7 points (p < 0.0001) on a scale of 1 to 10 points. Also on a scale of 1 to 10, the blinded mean qualitative anastomoses score improved from 4.8 ± 2.2 points (poor) to 8.0 ± 1.1 points (good) (p < 0.0001). The mean time to complete the curriculum was 5.5 ± 1.4 hours, and, on a scale of 1 to 10, curriculum utility was rated by the residents to be 8 ± 1.8 points. The cost of the initial setup was $1,795 with a yearly utilization cost per resident of $42. CONCLUSIONS: The implementation of a self-directed curriculum utilizing synthetic microvessels and nonliving models demonstrated significant improvements in resident microvascular skill. This curriculum represents a modest startup cost and low yearly cost per resident.


Assuntos
Competência Clínica/normas , Internato e Residência/métodos , Microcirurgia/educação , Procedimentos Ortopédicos/educação , Ortopedia/educação , Anastomose Cirúrgica , Custos e Análise de Custo , Currículo , Humanos , Internato e Residência/economia , Microcirurgia/economia , Microvasos/cirurgia , Modelos Anatômicos , Duração da Cirurgia , Procedimentos Ortopédicos/economia , Procedimentos Ortopédicos/normas , Ortopedia/economia , Ortopedia/normas , Estados Unidos
18.
Ir J Med Sci ; 188(3): 861-866, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30456515

RESUMO

OBJECTIVES: Currently in Ireland, there is a lack of uniformity regarding the method in which the consent process is routinely documented. The purpose of this study was to evaluate the standard consent forms used in elective orthopaedic hospitals in Ireland. In addition, this paper explores the relevant guidelines from the UK and Ireland relating to consent documentation. METHODS: Standard consent forms used in the 24 public hospitals that perform elective orthopaedic surgery were analysed and compared, based on the inclusion or exclusion of 22 unique consent-related items or statements selected by the authors. In addition, each form was analysed for format, word count, and readability. RESULTS: Within 24 hospitals with elective orthopaedic surgery, there were 21 unique consent forms being used. There was a mean inclusion of 9.5 of the 22 unique items per form with a standard deviation of 5.1 (range 2-18), indicating a wide discrepancy. For each unique consent-related item in the analysis, the mean rate of inclusion was 43.4% (SD 26.7%). The mean Flesch Reading Ease Score was 43.3. The format varied from 1 to 4 pages, with a word count of 109 to 1041 (mean 414.7). CONCLUSION: The findings demonstrate a lack of uniformity of both format and content amongst the consent forms currently being used in elective orthopaedic hospitals in Ireland. This paper supports the use of a nationally standardised consent documentation method in order to improve the efficiency of the consent process and ensure greater protection against litigation.


Assuntos
Termos de Consentimento/normas , Procedimentos Cirúrgicos Eletivos/normas , Procedimentos Ortopédicos/normas , Ortopedia/normas , Humanos
20.
Z Orthop Unfall ; 157(4): 411-416, 2019 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-30481837

RESUMO

This manuscript evaluates the recent standard concept for clubfoot treatment. With regard to the history of clubfoot therapy and the return to conservative methods, the focus is laid on Ponseti's treatment concept. Due to its development according to the precise analysis of the pathoanatomy, the practical principle is simple and easy to learn and consists basically of two redression maneuvers, percutaneous achillotenotomy, and boots and bar abduction treatment. Therefore, about 60 years after its implementation in Iowa it can be said to be the worldwide golden standard. It is known that Ponseti treated feet are better with regard to function and pain when compared to surgically treated clubfeet. The best results can be achieved when one sticks exactly to the method. Hence, plaster of Paris above the knee casts yield better results than fibreglass materials or short-leg casts. The brace should be worn 23 hours a day for 3 months and during sleep until the fourth birthday of the child. For reasons including the structured concept of treating relapses, the method is applicable in high and low income countries. Before transferring the tibialis anterior tendon, it is mandatory to correct the relapse of the heel varus. The Ponseti method can also correct clubfeet of non-idiopathic origin. Although a higher rate of relapses must be expected in these cases, initial Ponseti treatment lowers the extent of the necessary surgery. Emphasis is put on the importance of counselling prenatally as well as during the boots and bar period. To yield the best results, it is necessary to train and counsel physicians as well as parents. There is no need to fear significant delay in reaching motor milestones when clubfeet are treated conservatively. Other conservative methods - such as the French physiotherapy method - are able to correct the deformity, but usually do not consist of a concept as structured as the Ponseti method. They are also often more time consuming for the families when compared to Ponseti's technique and are not available ubiquitously. While the diagnosis of the clubfoot deformity is still a clinical one and scores are the main tools for grading the severity today followed by X-rays and to some extent sonography, in experimental settings MRI may be helpful in finding abnormalities in muscles, blood vessels, and cartilage structures. The study of genetic associations of pathway abnormalities and single nucleotide polymorphisms with regard to the development of clubfeet enhances our knowledge concerning the origin of the deformity during limb development. In the future, this may enable us to provide not only a better prognosis for the outcome but also a more individualised therapy for each child born with a clubfoot.


Assuntos
Moldes Cirúrgicos/normas , Pé Torto Equinovaro/cirurgia , Tenotomia/normas , Criança , Pé Torto Equinovaro/terapia , Humanos , Procedimentos Ortopédicos/métodos , Procedimentos Ortopédicos/normas , Tenotomia/métodos , Resultado do Tratamento
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