Implementation of a Decision Aid for Hip and Knee Osteoarthritis in Orthopedics: A Mixed-Methods Process Evaluation.

BACKGROUND: In orthopedics, the use of patient decision aids (ptDAs) is limited. With a mixed-method process evaluation, we investigated patient factors associated with accepting versus declining the use of the ptDA, patients' reasons for declining the ptDA, and clinicians' perceived barriers and facilitators for its use. METHODS: Patients with an indication for joint replacement surgery (N = 153) completed questionnaires measuring demographics, physical functioning, quality of life (EQ-5D-3L), and a visual analog scale (VAS) pain score at 1 time point. Subsequently, their clinician offered them the relevant ptDA. Using a retrospective design, we compared patients who used the ptDA (59%) with patients who declined (41%) on all these measures as well as the chosen treatment. If the use of the ptDA was declined, patients' reasons were recorded by their clinician and analysed (n = 46). To evaluate the experiences of clinicians (n = 5), semistructured interviews were conducted and thematically analyzed. Clinicians who did not use the ptDA substantially (<10 times) were also interviewed (n = 3). RESULTS: Compared with patients who used the ptDA, patients who declined use had higher VAS pain scores (7.2 v. 6.2, P < .001), reported significantly worse quality of life (on 4 of 6 EQ-5D-3L subscales), and were less likely to receive nonsurgical treatment (4% v. 28%, P < .001). Of the patients who declined to use the ptDA, 46% said they had enough information and felt ready to make a decision without the ptDA. The interviews revealed that clinicians considered the ptDAs most useful for newly diagnosed patients who had not received previous treatment. CONCLUSION: These results suggest that the uptake of a ptDA may be improved if it is introduced in the early disease stages of hip and knee osteoarthritis. HIGHLIGHTS: Patients who declined the use of a patient decision aid (ptDA) for hip and knee osteoarthritis reported more pain and worse quality of life.Most patients who declined to use a ptDA felt sufficiently well informed to make a treatment decision.Patients who declined the ptDA were more likely to have received prior treatment in primary care.Clinicians found the ptDA to be a helpful addition to the consultation, particularly for newly diagnosed patients.

Risk Factors of Bone Nonfusion After Spinal Tuberculosis Debridement Bone Graft Fusion and Internal Fixation.

Objective: To retrospectively analyze bone graft nonfusion risk factors in spinal tuberculosis patients after lesion debridement, bone graft fusion and internal fixation. Methods: The clinical data of 131 patients who underwent spinal tuberculosis debridement, bone graft fusion and internal fixation in our hospital from March 2015 to March 2018 were retrospectively analyzed. The patients were divided into two groups according to bone fusion after the operation; there were 37 patients in the nonfusion group and 94 in the fusion group. The basic information and follow-up data of the patients were collected to evaluate the risk factors for bone graft nonfusion 1 year after surgery. Results: The severity of osteoporosis in the nonfusion group was significantly greater than that in the fusion group (p < 0.05). There were statistically significant differences between the two groups in terms of continuous multisegment status, disease duration, intraoperative surgical methods and whether patients received standardized drug treatment for 12 months after surgery (p < 0.05). Multivariate logistic regression analysis showed that long disease duration, posterior approach, and degree of osteoporosis were risk factors for postoperative bone graft nonfusion (OR > 1, p < 0.05), while standard drug treatment for 1 year after surgery was a protective factor (OR < 1, p < 0.05). Conclusion: Spinal tuberculosis patients who had a long disease course, who underwent simple posterior debridement, or who had severe osteoporosis had a higher risk of bone graft nonfusion after surgery. Tuberculosis treatment is beneficial for the osseous fusion of the postoperative bone graft area.

The Management of Distal Clavicle Fractures - A Survey of UK Shoulder and Elbow Surgeons.

Background Distal clavicle fractures (DCF) are a management challenge frequently encountered by shoulder surgeons. Despite an array of surgical fixation strategies, the indications and role of surgery are unclear, with there being no gold standard or consensus regarding their management. The aim of this study was to identify current United Kingdom (UK) clinical practices relating to DCFs and to inform a future randomised control trial (RCT). Methods An online survey was sent to the consultant surgeon members of the British Elbow and Shoulder Society (BESS). Questions covered respondent indications for surgical fixation, important factors considered for management of DCFs, fixation strategies, the volume of patients treated, and willingness to participate in the conduct of a randomized trial. Results The response rate was 84/327 (26%). 64-67% of respondents reported surgically managing DCFs classified as Neer type 2A, 2B and 5. The most important factors considered by surgeons when deciding between operative and nonoperative intervention were degree of displacement (90%), clinical assessment of impending open fracture (87%), and age of the patient (74%). For conservatively managed DCFs, the preferred length of complete immobilization was 2-4 weeks (46%), followed by 4-8 weeks (17%). 30% reported not immobilizing their patients at all. For operative intervention, the locking plate was the preferred fixation method by most respondents (68%), although there was no clear consensus regarding other fixation methods. Most surgeons (52%) reported treating a low volume of patients with DCFs (0-10) per year. 58% of respondents were willing to randomize patients to non-operative treatment in a multi-centre RCT, with a further 22% undecided. Finally, 68% (n=79) of respondents would consider being co-investigators in such a trial. Conclusion There is considerable heterogeneity in the management of patients with DCFs in the UK. The indications for surgery and the optimal surgical fixation method remain uncertain. There is a clear need for pragmatic multi-centre clinical research in this area.

Assessing the Quality of Orthopaedic Operation Notes in Accordance With the Royal College of Surgeons Guidelines: An Audit Cycle.

Introduction Accurate and detailed operation notes are of great importance in all surgical specialties not only for patient care but also for providing information for research, audit and medico-legal purposes. In this audit cycle, we assessed the quality of operation notes against the standards set by the Royal College of Surgeons of England. Methodology A sample of 59 operation notes was randomly selected from the orthopaedics department at Ribat University Hospital and retrospectively audited by three reviewers according to the Royal College of Surgeons of England Good Surgical Practice guidelines released in 2014. A memory aid was then placed in the operation theatre, emphasising mainly the points with poor compliance in the audit. A re-audit was then performed for another 59 operation notes. Results During the first audit, 59 elective operation notes were reviewed, and there was good compliance with date documentation (86%), diagnosis (85%), operating surgeon (90%), assistants' names (86%), operative procedure (98%), detailed post-operative instructions (98%) and the signature (75%). In the re-audit phase, another 59 operative notes were reviewed; four of them were emergency operations. An improvement was noted in documenting the information that had been poorly documented in the first audit. In the first audit, 20% of the operation notes were written by the operating surgeon, while only 14% were written by the operating surgeon in the re-audit. Conclusion Our implementation of a memory aid in the operation theatre helped to improve the reporting of some of the criteria; however, some components of the operation notes remained poorly filled in.

Considerations of Conservative Treatment After a Partial Ulnar Collateral Ligament Injury in Overhead Athletes: A Systematic Review.

CONTEXT: Ulnar collateral ligament (UCL) reconstructions continue to increase without consensus on an evidence-based treatment protocol for nonoperative management. Currently, there is no consensus on an effective nonoperative protocol for partial UCL injuries that uses return-to-play (RTP) rates in determining the outcome of conservative treatment. OBJECTIVE: To systematically review RTP rates after conservative treatment of partial UCL injuries in overhead athletes along with descriptive components of each conservative intervention to identify an effective evidence-based nonoperative rehabilitation protocol. DATA SOURCES: Articles in PubMed, CINAHL, MEDLINE, Academic Search Complete, and SPORTDiscus were identified in October 2018 based on the following terms: overhead athlete, ulnar collateral ligament, nonoperative treatment, and return to play. STUDY SELECTION: Seven retrospective, level 4 studies (n = 196) qualified for analysis. STUDY DESIGN: Systematic review. LEVEL OF EVIDENCE: Level 4. DATA EXTRACTION: Study design, level of evidence, demographics, sample size, sports involved, level of competition, grade or type of UCL diagnosis, conservative treatment components, and percentage RTP were extracted. RESULTS: Overall, RTP rates after conservative treatment ranged between 42% and 100% (mean, 78% ± 20%). The most frequently reported components of rehabilitation protocols were (1) a period of rest, (2) stretching, (3) strengthening, and (4) a throwing program. Platelet-rich plasma injections were included in 5 (71%) of the 7 protocols with a rehabilitation period. CONCLUSION: Conservative treatment is a viable option for partial UCL tears in overhead athletes. A successful rehabilitation protocol includes the use of patient-reported outcomes, a sport-specific tailored treatment plan, kinetic chain strengthening, and an interval throwing program. Factors such as age, grading of tear, level of play, sport, and athlete's perceived well-being should all be considered during treatment decisions.

Aplicación de los modelos mecanobiológicos en los procesos de regeneración ósea / Application of mechano-biological models in bone regeneration process

Los modelos computacionales constituyen una herramienta necesaria en las investigaciones científicas. En este trabajo se muestra la utilización de las nuevas tecnologías, a través del Método de los Elementos Finitos en la implementación de los modelos mecanobiológicos usados en ortopedia. Se exponen los principales modelos mecano-reguladores que aparecen en la bibliografía y se ejemplifican las ventajas que proporcionan las técnicas de modelación en el pronóstico de la formación de nuevo tejido óseo, como respuesta biológica del organismo debido a la aplicación de cargas externas(AU)

Computational models are a necessary tool in scientific researches. This paper deals with the use of new technologies, by using the Finite Element Method for the implementation of mechano-biological models used in orthopedic. Also the main mechano-regulator models are shown in this article, which are described in literature. On the other hand, the advantages provided by the modeling techniques during the prognosis of the new tissue formation, as a response of the organism to the application of external loads are stated by these authors(AU)

Les modèles informatisées constituent un outil nécessaire dans les recherches scientifiques. Dans ce travail, on montre lusage des nouvelles technologies, telle que la méthode des Éléments finis, dans la mise en application des modèles biomécaniques utilisés en orthopédie. On fait une révision des modèles mécano-régulateurs principaux apparus dans la littérature, et on met des exemples des bénéfices obtenus par les techniques de modélisation dans le pronostic de formation du nouveau tissu osseux comme réponse biologique du corps aux charges externes(AU)

Encuesta de percepción de competencias en médicos residentes de Ortopedia y Traumatología en un hospital de Yucatán, México / Competence perception survey among Residents of Orthopedics and Trauma in a hospital of Yucatán México

Antecedentes: El modelo por competencias plantea que lo más importante es poseer elementos para la solución de problemas, ya que una preparación en abstracto no cuenta con suficientes herramientas para solucionarlos. Para ello utiliza competencias centrales y auxiliares que están vinculadas a valores destacando las actitudes. Para explorar estas competencias se hizo el presente estudio. Material y métodos: Estudio transversal, observacional y descriptivo. Se aplicó una encuesta anónima con datos del perfil de médicos residentes de Ortopedia y Traumatología que contenía 14 preguntas que se aplicaron a residentes que cursan diferentes grados académicos. Resultados: En la encuesta participaron 24 residentes de los 35 registrados en el curso. En 100% de ellos aceptó responder la encuesta, 54% cursaban el segundo grado, 29% primer grado y 17% cuarto grado. El 75% manifestó desarrollo de competencias auxiliares, 13% no respondió, 8% desarrollaron competencias centrales y 4% lo ignora. Conclusiones: Se manifestaron tres factores principales que influyen negativamente para mejorar el saber hacer en Ortopedia. El más relevante es que los médicos residentes describen una mala actitud de los médicos adscritos, falta de disponibilidad para enseñar y la mala relación interpersonal entre ellos. Se debe crear conciencia en los especialistas en formación de Ortopedia, que poseer sólo conocimientos y habilidades no es suficiente para abordar integralmente los problemas de salud para cada paciente, ya que se debe motivar el desarrollo de mejores competencias, en especial las centrales.

Background: The competence model states that what is most important is to have the elements to solve problems since abstract training does not provide enough tools to solve them. Therefore, it uses key and auxiliary competences that are linked to values such as attitudes. This study was performed to explore these competences. Material and methods: This is a cross sectional, observational and descriptive trial. An anonymous survey with profile data of Orthopedics and Trauma residents was given, it contained 14 questions for residents of different academic levels. Results: 24 residents participated out of the 35 registered in the course. 100% agreed to answer the survey, 54% was in the second year, 29% in the first year and 17% in the fourth year. 75% expressed auxiliary competences, 13% did not respond, 8% developed key competences and 4% don't know. Conclusions: Three main factors that are a negative influence to improve the knowledge of orthopedics were expressed. The most relevant is that residents describe a bad attitude from attending physicians, lack of willingness to teach and poor interpersonal relationships. Awareness should be raised among orthopedics specialists so they understand that having the knowledge and skills is not enough to approach health issues in a comprehensive manner for each patient and the development of better competences should be fostered, especially key competences.

Aplicación de los modelos mecanobiológicos en los procesos de regeneración ósea / Application of mechano-biological models in bone regeneration process / Mise en application des modèles biomécaniques dans les processus de régénération osseuse

Los modelos computacionales constituyen una herramienta necesaria en las investigaciones científicas. En este trabajo se muestra la utilización de las nuevas tecnologías, a través del Método de los Elementos Finitos en la implementación de los modelos mecanobiológicos usados en ortopedia. Se exponen los principales modelos mecano-reguladores que aparecen en la bibliografía y se ejemplifican las ventajas que proporcionan las técnicas de modelación en el pronóstico de la formación de nuevo tejido óseo, como respuesta biológica del organismo debido a la aplicación de cargas externas.

Computational models are a necessary tool in scientific researches. This paper deals with the use of new technologies, by using the Finite Element Method for the implementation of mechano-biological models used in orthopedic. Also the main mechano-regulator models are shown in this article, which are described in literature. On the other hand, the advantages provided by the modeling techniques during the prognosis of the new tissue formation, as a response of the organism to the application of external loads are stated by these authors.

Les modèles informatisées constituent un outil nécessaire dans les recherches scientifiques. Dans ce travail, on montre l’usage des nouvelles technologies, telle que la méthode des Éléments finis, dans la mise en application des modèles biomécaniques utilisés en orthopédie. On fait une révision des modèles mécano-régulateurs principaux apparus dans la littérature, et on met des exemples des bénéfices obtenus par les techniques de modélisation dans le pronostic de formation du nouveau tissu osseux comme réponse biologique du corps aux charges externes.