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1. Responsiveness and Minimal Important Change of the IKDC of Middle-Aged and Older Patients With a Meniscal Tear

Author

Bart J. Burger, Igor C.J.B. van den Brand, Anne E. Wijsbek, Arthur de Gast, Daniel Haverkamp, Sheila Sprague, Dirk Jan F Moojen, Julius Wolkenfelt, Gino M. M. J. Kerkhoffs, Derek F.P. van Deurzen, Dirk Jan Hofstee, Nienke Wolterbeek, Wahid Rezaie, Andy B. Spoor, Olivier J.F. Nijland, Ewoud R.A. van Arkel, Taco Gosens, Daniel B.F. Saris, Nienke W. Willigenburg, Vanessa A. Scholtes, Matthijs R. Krijnen, Rolf W. Peters, Jelle J. Halma, Ben W.J. Mol, Lidwine B. Mokkink, Coen H. Bloembergen, Victor A. van de Graaf, Thijs A. van Rheenen, Suzanne de Vos-Jakobs, Rudolf W. Poolman, Anton M.J.S. Vervest, Julia C A Noorduyn, Ise K Butter, Bregje J.W. Thomassen, Maurits W. van Tulder, Camille Neeter, Eduard L.A.R. Mutsaerts, Thom E Snijders, APH - Methodology, Orthopedic Surgery and Sports Medicine, Surgery, Neuromechanics, AMS - Restoration and Development, Health Sciences, AMS - Ageing and Morbidity, AMS - Sports and Work, and APH - Societal Participation & Health

Subjects
Adult, Male, medicine.medical_specialty, SDG 16 - Peace, Knee Joint, knee, Physical Therapy, Sports Therapy and Rehabilitation, Documentation, Knee Injuries, Meniscus (anatomy), Menisci, Tibial, clinimetrics, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Older patients, meniscus, Surveys and Questionnaires, measurement properties, medicine, Humans, Orthopedics and Sports Medicine, 030212 general & internal medicine, Patient Reported Outcome Measures, Physical Therapy Modalities, IKDC, Aged, Meniscectomy, business.industry, SDG 16 - Peace, Justice and Strong Institutions, 030229 sport sciences, Middle Aged, Justice and Strong Institutions, Clinical trial, medicine.anatomical_structure, Physical therapy, Female, business
Abstract

Background: Responsiveness and the minimal important change (MIC) are important measurement properties to evaluate treatment effects and to interpret clinical trial results. The International Knee Documentation Committee (IKDC) Subjective Knee Form is a reliable and valid instrument for measuring patient-reported knee-specific symptoms, functioning, and sports activities in a population with meniscal tears. However, evidence on responsiveness is of limited methodological quality, and the MIC has not yet been established for patients with symptomatic meniscal tears. Purpose: To evaluate the responsiveness and determine the MIC of the IKDC for patients with meniscal tears. Study Design: Cohort study (design); Level of evidence 2. Methods: This study was part of the ESCAPE trial: a noninferiority multicenter randomized controlled trial comparing arthroscopic partial meniscectomy with physical therapy. Patients aged 45 to 70 years who were treated for a meniscal tear by arthroscopic partial meniscectomy or physical therapy completed the IKDC and 3 other questionnaires (RAND 36-Item Health Survey, EuroQol-5D-5L, and visual analog scales for pain) at baseline and 6-month follow-up. Responsiveness was evaluated by testing predefined hypotheses about the relation of the change in IKDC with regard to the change in the other self-reported outcomes. An external anchor question was used to distinguish patients reporting improvement versus no change in daily functioning. The MIC was determined by the optimal cutoff point in the receiver operating characteristic curve, which quantifies the IKDC score that best discriminated between patients with and without improvement in daily function. Results: Data from all 298 patients who completed baseline and 6-month follow-up questionnaires were analyzed. Responsiveness of the IKDC was confirmed in 7 of 10 predefined hypotheses about the change in IKDC score with regard to other patient-reported outcome measures. One hypothesis differed in the expected direction, while 2 hypotheses failed to meet the expected magnitude by 0.02 and 0.01 points. An MIC of 10.9 points was calculated for the IKDC of middle-aged and older patients with meniscal tears. Conclusion: This study showed that the IKDC is responsive to change among patients aged 45 to 70 years with meniscal tears, with an MIC of 10.9 points. This strengthens the value of the IKDC in quantifying treatment effects in this population.

Published
2019
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2. Functional outcomes of arthroscopic partial meniscectomy versus physical therapy for degenerative meniscal tears using a patient-specific score

Author

Andy B. Spoor, Ewoud R.A. van Arkel, Julius Wolkenfelt, Victor A. van de Graaf, Nienke Wolterbeek, Nienke W. Willigenburg, Vanessa A. Scholtes, Rogier van Dijk, Taco Gosens, Igor C.J.B. van den Brand, Dirk Jan Hofstee, Bart J. Burger, Rolf W. Peters, Derek F.P. van Deurzen, J van der Kraan, Matthijs R. Krijnen, Gino M. M. J. Kerkhoffs, Thijs A. van Rheenen, Maurits W. van Tulder, Daniel B.F. Saris, Wahid Rezaie, Suzanne de Vos-Jakobs, Ise K Butter, Sheila Sprague, Dirk Jan F Moojen, Camille Neeter, Eduard L.A.R. Mutsaerts, Thom E Snijders, Mirjam Schavemaker, Anton M.J.S. Vervest, Bregje J.W. Thomassen, Tess Glastra van Loon, Anne E. Wijsbek, Arthur de Gast, Michel W. Coppieters, Daniel Haverkamp, Coen H. Bloembergen, Rudolf W. Poolman, Gwendolyne G M Scholten-Peeters, Julia C A Noorduyn, Orthopaedic Surgery, AMS - Sports, AMS - Ageing & Vitality, Surgery, Amsterdam Movement Sciences, Graduate School, Radiology and Nuclear Medicine, AMS - Rehabilitation & Development, Neuromechanics, Kinesiology, AMS - Musculoskeletal Health, Faculty of Behavioural and Movement Sciences, APH - Methodology, and APH - Societal Participation & Health

Subjects
medicine.medical_specialty, Meniscal tears, Meniscus (anatomy), Article, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, meniscus, law, Medicine, Orthopedics and Sports Medicine, Knee, physical therapy, 030212 general & internal medicine, 030222 orthopedics, arthroscopic surgery, business.industry, Patient-Specific Functional Scale, SDG 10 - Reduced Inequalities, Patient specific, medicine.anatomical_structure, Physical therapy, business
Abstract

Background: It is unknown whether the treatment effects of partial meniscectomy and physical therapy differ when focusing on activities most valued by patients with degenerative meniscal tears. Purpose: To compare partial meniscectomy with physical therapy in patients with a degenerative meniscal tear, focusing on patients’ most important functional limitations as the outcome. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: This study is part of the Cost-effectiveness of Early Surgery versus Conservative Treatment with Optional Delayed Meniscectomy for Patients over 45 years with non-obstructive meniscal tears (ESCAPE) trial, a multicenter noninferiority randomized controlled trial conducted in 9 orthopaedic hospital departments in the Netherlands. The ESCAPE trial included 321 patients aged between 45 and 70 years with a symptomatic, magnetic resonance imaging–confirmed meniscal tear. Exclusion criteria were severe osteoarthritis, body mass index >35 kg/m2, locking of the knee, and prior knee surgery or knee instability due to an anterior or posterior cruciate ligament rupture. This study compared partial meniscectomy with physical therapy consisting of a supervised incremental exercise protocol of 16 sessions over 8 weeks. The main outcome measure was the Dutch-language equivalent of the Patient-Specific Functional Scale (PSFS), a secondary outcome measure of the ESCAPE trial. We used crude and adjusted linear mixed-model analyses to reveal the between-group differences over 24 months. We calculated the minimal important change for the PSFS using an anchor-based method. Results: After 24 months, 286 patients completed the follow-up. The partial meniscectomy group (n = 139) improved on the PSFS by a mean of 4.8 ± 2.6 points (from 6.8 ± 1.9 to 2.0 ± 2.2), and the physical therapy group (n = 147) improved by a mean of 4.0 ± 3.1 points (from 6.7 ± 2.0 to 2.7 ± 2.5). The crude overall between-group difference showed a –0.6-point difference (95% CI, –1.0 to –0.2; P = .004) in favor of the partial meniscectomy group. This improvement was statistically significant but not clinically meaningful, as the calculated minimal important change was 2.5 points on an 11-point scale. Conclusion: Both interventions were associated with a clinically meaningful improvement regarding patients’ most important functional limitations. Although partial meniscectomy was associated with a statistically larger improvement at some follow-up time points, the difference compared with physical therapy was small and clinically not meaningful at any follow-up time point. Registration: NCT01850719 ( ClinicalTrials.gov identifier) and NTR3908 (the Netherlands Trial Register).

Published
2020
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3. Clinical and radiological outcome of minimally invasive posterior lumbar interbody fusion in primary versus revision surgery

Author

B. L. den Oudsten, B. Hentenaar, C. H. Diekerhof, A. B. Spoor, J. de Waal Malefijt, and Medical and Clinical Psychology

Subjects
Adult, Male, Reoperation, medicine.medical_specialty, 03 medical and health sciences, Disability Evaluation, 0302 clinical medicine, Quality of life, Lumbar interbody fusion, Recurrence, medicine, Humans, Minimally Invasive Surgical Procedures, Orthopedics and Sports Medicine, Intervertebral Disc, Radiculopathy, Aged, Pain Measurement, Retrospective Studies, 030222 orthopedics, Lumbar Vertebrae, business.industry, Retrospective cohort study, Middle Aged, medicine.disease, Spondylolisthesis, humanities, Surgery, Oswestry Disability Index, Spinal Fusion, Treatment Outcome, Radiological weapon, Orthopedic surgery, Female, Fusion rate, business, 030217 neurology & neurosurgery, Intervertebral Disc Displacement, Follow-Up Studies, Research Article
Abstract

PurposeThe aim of this study is to compare the clinical and radiological outcome of minimally invasive posterior lumbar interbody fusion (MI-PLIF) in revision and primary cases.MethodsIn a retrospective study, we compared the clinical and radiological results of MI-PLIF for lytic spondylolisthesis (n = 28) and recurrent radiculopathy after herniated disc surgery (n = 28). Clinical outcome was assessed using the visual analogue score (VAS) and Oswestry Disability Index (ODI). Quality of life was assessed with the Euroqol-5d (EQ5D), the EQ5D VAS and the WHOQOL-BREF.ResultsThe follow-up was 5.1 (SD 2.3) years. The decrease in VAS scores was significant and comparable in both groups. We found significantly better ODI and quality of life scores for the patients with lytic spondylolisthesis. The radiological outcome showed only one non-union, and subsidence occurred in both groups at an equal amount.ConclusionThe MI-PLIF technique is a safe procedure with only few complications and a high fusion rate. It was successful in both groups, but the quality of life and ODI are better in primary cases.

Published
2016
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4. Interobserver variability in the treatment of little finger metacarpal neck fractures

Author

Lewis B. Lane, Rick F. Papandrea, Minoo Patel, P. Hahn, Andrew H. Schmidt, Gerald A. Kraan, William Dias Belangero, David E. Ruchelsman, Henry Broekhuyse, J. H. Scheer, Vassilios S. Nikolaou, Travis M. Hughes, C.J.H. Veillette, N. Bijlani, Aida Garcia, Charles Cassidy, S. Moghtaderi, M. A J Van De Sande, Timothy Omara, B. Watkins, E. Forigua Jaime, C. Young, Philipp N. Streubel, A. Berner, R. de Bedout, M. P. J. van den Bekerom, Maurizio Calcagni, Grant Bayne, T. Higgins, Mahmoud I. Abdel-Ghany, Rick Tosti, L. C. Bainbridge, Matthew Rg Menon, Lior Paz, M. Soong, Warren C. Hammert, Yoram A. Weil, Randy M. Hauck, Grant E. Garrigues, S. G. Kaar, D.M. Silva, Thomas G. Stackhouse, Richard L. Hutchison, Augustus D. Mazzocca, Lars C. Borris, M. Quell, Fabio Suarez, Daniel Haverkamp, Chris Wilson, R. Omid, Gladys Cecilia Zambrano Caro, Daniel B. Polatsch, Theodoros I. Tosounidis, Marco Rizzo, Jose Nolla, F. García, Richard S. Page, Charalampos G. Zalavras, Asif M. Ilyas, E.T. Tolo, Megan M. Wood, H. Durchholz, G. Kohut, Michael J. Behrman, Peter Kloen, Christos Garnavos, David L. Nelson, Charles A. Goldfarb, R. Gaston, Michael W. Kessler, Koroush Kabir, Chad Manke, John M. Erickson, Thomas Mittlmeier, Prosper Benhaim, Seth D. Dodds, V. Philippe, K. Dickson, Richard Buckley, Karel Chivers, Bernard F. Hearon, Jonathan Isaacs, M. Ladislav, H. Goost, Peter R. Brink, Edward J. Harvey, Richard S. Gilbert, D.K. Kirkpatrick, Ronald Liem, H. W. Grunwald, R. Wallensten, Sergio Rowinski, Jim Calandruccio, Minos Tyllianakis, G.J. Della Rocca, H. B. Bamberger, Thomas J. Fischer, Kevin J. Malone, Marc J. Richard, Saurabh P. Mehta, Niels W. L. Schep, E.M. Hammerberg, Peter Schandelmaier, Jeffrey Wint, German Ricardo Hernandez, J. Moreta-Suarez, Christopher M. Jones, Taizoon Baxamusa, Martin I. Boyer, W.T. Benjamin, Jennifer Moriatis Wolf, M. Bonczar, Jos J. Mellema, J. Munyak, Julie E. Adams, Matej Kastelec, Milind Merchant, Erik T. Walbeehm, Robert Haverlag, Thomas Apard, C. Klostermann, Sanjeev Kakar, Peter J. L. Jebson, N.L. Leung, A. L. Van Der Zwan, W. A. Batson, Lob Guenter, Denise Eygendaal, S.A. Meylaerts, Renato M. Fricker, Anže Kristan, Michael W. Grafe, T. Begue, Kevin Eng, D. F. P. van Deurzen, Steven Beldner, Martin Richardson, C. J. Barreto, J.F. Di Giovanni, Lars Adolfsson, M. Darowish, Gregory L. DeSilva, Gary K. Frykman, K. Erol, Theresa O Wyrick, Evan D. Schumer, Christopher B. Wall, Antonio Barquet, L.M.S.J. Poelhekke, Scott A. Mitchell, Paul M. Guidera, Constanza L. Moreno-Serrano, E. Stojkovska Pemovska, Frank L. Walter, Michael J. Prayson, John A. McAuliffe, N. Elias, Robert D. Zura, Christopher J. Wilson, Marc F. Swiontkowski, Oleg M. Semenkin, Russell Shatford, Jack Choueka, Ryan P. Calfee, Gary M. Pess, Stanley Casimir Marczyk, C. Taleb, Andrew P. Gutow, Nikolaos K. Kanakaris, Neil Wilson, John T. Capo, Vincenzo Giordano, C. D. Oliveira Miranda, J. Itamura, Joseph M. Conflitti, A. B. Shafritz, George S.M. Dyer, Ralph M. Costanzo, B. E. Kreis, Carl Ekholm, R. Cardoso, Scott F. M. Duncan, David Ring, Nicholas L. Shortt, A.J.H. Vochteloo, Lawrence Weiss, A. Platz, Valentin Neuhaus, T. Havlicek, Charles Metzger, Andrew L. Terrono, Thierry G. Guitton, Kendrick E. Lee, Marinis Pirpiris, Thomas W. Wright, Gertraud Gradl, Georg M. Huemer, B. M. Nolan, David M. Kalainov, D.O. Oloruntoba, Paul A. Martineau, Sander Spruijt, Kyle J. Jeray, Carlos Henrique Fernandes, Frank J. Raia, G. C. Babis, J. Biert, P. Lygdas, Axel Jubel, Brian P.D. Wills, Michael A. Baskies, Peter L. Althausen, Kevin M. Rumball, Rodrigo Pesantez, Mohamed Shafi, Harold Alonso Villamizar, Carrie R. Swigart, Francisco Lopez-Gonzalez, Frede Frihagen, Thomas Dienstknecht, Saul Kaplan, Matt Mormino, M. J. Palmer, Thomas A. DeCoster, A. B. Spoor, Job N Doornberg, W. Satora, Todd E. Siff, Eric P. Hofmeister, Joshua M. Abzug, George W. Balfour, J. C. Goslings, P. Inna, Stephen A. Kennedy, Parag Melvanki, Jochen Fischer, Raymond Malcolm Smith, P. V. van Eerten, George S. Athwal, Diederik O. Verbeek, D. Brilej, L.A.B. Campinhos, Daniel A. Osei, K.J. Ponsen, Iain McGraw, Michael Nancollas, R. van Riet, Philip E. Blazar, C. Cornell, Craig A. Bottke, Taco Gosens, F. T. D. Kaplan, George M. Kontakis, Graduate School, Orthopedic Surgery and Sports Medicine, Other departments, Surgery, Other Research, and AMS - Amsterdam Movement Sciences

Subjects
Adult, Male, medicine.medical_specialty, Radiography, Fractures, Bone, Random Allocation, Finger Injuries, medicine, Humans, Lateral view, Orthopedics and Sports Medicine, Practice Patterns, Physicians', Nonoperative management, Aged, Observer Variation, Orthodontics, business.industry, Other Research Radboud Institute for Health Sciences [Radboudumc 0], Neck fracture, Little finger, Middle Aged, Surgery, medicine.anatomical_structure, Reconstructive and regenerative medicine Radboud Institute for Molecular Life Sciences [Radboudumc 10], Orthopedic surgery, Female, Metacarpus, business, Angular deformity
Abstract

Purpose To address the null hypothesis that surgeons shown radiographs of little finger metacarpal neck fractures with measured fracture angulation would recommend surgery as often as surgeons shown unmarked radiographs. Methods Members of the Science of Variation Group, an international collaboration of fully trained orthopedic and trauma surgeons, were asked to review 20 little finger metacarpal neck fracture cases, which included a vignette and 3 high-quality radiographs. Members were then randomized to review radiographs with or without measured fracture angulation on the lateral view and select operative or nonoperative management. Results Surgeons shown radiographs with measured angulation were more likely to recommend surgery, and there was less variability among these surgeons, particularly for fractures with less angular deformity. Conclusions Measured fracture angulation has a small but significant influence on treatment recommendations for little finger metacarpal neck fractures. Copyright (C) 2014 by the American Society for Surgery of the Hand. All rights reserved

Published
2014

5. Long-term results and arthropathy following the modified Bristow–Latarjet procedure

Author

J. de Waal Malefijt and A. B. Spoor

Subjects
Adult, Male, medicine.medical_specialty, Adolescent, Shoulders, Osteoarthritis, Recurrence, Risk Factors, Bristow-Latarjet procedure, Arthropathy, Humans, Medicine, Orthopedic Procedures, Orthopedics and Sports Medicine, Retrospective Studies, Subluxation, Original Paper, business.industry, Shoulder Dislocation, Incidence (epidemiology), Retrospective cohort study, medicine.disease, Surgery, Treatment Outcome, Orthopedic surgery, Female, business, Follow-Up Studies
Abstract

The incidence of early osteoarthritis after the modified Bristow procedure has been the subject of several articles during the last decade. Recurrent dislocation, recurrent subluxation after surgery or the procedure itself have been suggested as the main causes of degenerative changes. We assessed 19 patients who underwent the Bristow procedure for recurrent anterior dislocations of the shoulder retrospectively. Only one redislocation occurred in 20 shoulders (six women and 13 men) with an average follow-up of 7.7 years. All patients were satisfied and experienced improved stability. Three patients showed arthritic changes (two mild and one moderate), which, surprisingly, were also seen in the opposite shoulder. We therefore conclude that the occurrence of arthropathic changes after surgical stabilisation is based on multiple factors, with the initial dislocation playing a major role.

Published
2005
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6. How surgeons make decisions when the evidence is inconclusive

Author

Prashanth Ina, Robert R.L. Gray, Gustavo Mantovani Ruggiero, David J. Rowland, Yoram Weil, M. R. de Vries, Renato M. Fricker, Georges Kohut, Antonio Barquet, Karl Josef Prommersberger, Takashi Sasaki, Eckart Schwab, Taco Gosens, Joseph M. Conflitti, David Ring, M. A. Aita, Ladislav Mica, Joseph A. Abboud, Michael Jones, Daniel Hernandez, Gregory L. DeSilva, Hal MccUtchan, Thomas W. Wright, Kendrick E. Lee, Marinis Pirpiris, Ian A. Harris, Marc F. Swiontkowski, Neil Wilson, Norah M. Harvey, Eric P. Hofmeister, Howard D. Routman, Lawrence Weiss, Nicholas L. Shortt, Jorge Rubio, Axel Jubel, John S. Taras, Gustavo Regazzi, Sergio L. Checchia, Jack Choueka, Jorge L. Orbay, Michael A. Baskies, Rolf Norlin, Vispi Jokhi, Todd E. Siff, Ashish S. Ranade, Lisa L. Lattanza, Jeff W. Johnson, Hans J. Kreder, Rozental, Cayón Cayón, Rajat Varma, Paul T. Appleton, Leonid I. Katolik, Asheesh Bedi, Filip Celestyn Dolatowski, Steve Kronlage, Paul M. Guidera, Elisabeth Prelog-Igler, David M. Kalainov, Charles L. Getz, Chunyan Jiang, Porcellini, A. Iossifidis, J Andrew I Trenholm, Frede Frihagen, K. Sprengel, Minos Tyllianakis, Steven J. McCabe, David Weiss, C. Taleb, Andrew P. Gutow, Sebastian Kluge, Jin Young Park, Michael R. Hausman, Paul A. Martineau, Michel P J Van Den Bekerom, W. A H Van Der Stappen, Thomas G. Stackhouse, Thomas Dienstknecht, Babst H. Reto, Jonathan L. Hobby, Iain McGraw, Tony Wanich, Augustus D. Mazzocca, Samir Sodha, J. Biert, Matthias Turina, Ines C. Lin, Daniel Rikli, Fischmeister Martin, Chad Manke, Roman Pfeifer, Lars C. Borris, M. Quell, Fabio Suarez, Daniel B. Whelan, John P. Evans, Michael Nancollas, Marco Rizzo, Lawrence S. Halperin, Carl Ekholm, David E. Tate, Steven J. Morgan, Betsy M. Nolan, F. J. Seibert, W. Arnnold Batson, Richard Barth, Brent Bamberger, A. B. Spoor, Seth D. Dodds, Jeffrey A. Greenberg, Victoria D. Knoll, Wade R. Smith, Michael D. McKee, Rolf W. Peters, Christopher J. Walsh, Jochen Fischer, Martin I. Boyer, Raymond Malcolm Smith, P. V. van Eerten, Philipp N. Streubel, Thomas B. Hughes, Milind Merchant, Peter J. L. Jebson, Bret C. Peterson, Theodoros H. Tosounidis, Luke S. Austin, David L. Nelson, M. R. Krijnen, K.J. Ponsen, Chris Wilson, Gladys Cecilia Zambrano Caro, Daniel B. Polatsch, Matthew D. Budge, Reza Omid, Louis W. Catalano, Emil H. Schemitsch, Roy G. LiemKulick, Richard S. Page, Michael W. Kessler, Donald Endrizzi, Anna N. Miller, Jorge G. Boretto, Peter Kloen, J. Michael Wiater, Fidel Ernesto, German Ricardo Hernandez, Leon S. Benson, Peter J. Evans, John Howlett, Verhofstad, Michael J. Behrman, A. L. Van Der Zwan, Ryan P. Calfee, Robert D. Zura, Leon Elmans, Anica Eschler, D. Kaplan, Richard S. Gilbert, F. Thomas, Johannes M. Rueger, Eon K. Shin, Sam Moghtaderi, Julie E. Adams, Jaimo Ahn, D. F. P. van Deurzen, Ralf Nyszkiewicz, W. Jaap Willems, Huub Van Der Heide, Aida Garcia, L.M.S.J. Poelhekke, Philip E. Blazar, Daniel C. Wascher, Luis Antonio Buendia, S. Prashanth, Peter Krause, Maarten W.G.A. Bronkhorst, Noah D. Weiss, Kyle J. Jeray, Ronald Liem, Andrew L. Terrono, Niels W. L. Schep, Sander Sprujt, Ryan Klinefelter, Robert Haverlag, Steven Beldner, Nikolaos G. Lasanianos, Ramon De Bedout, Rudolf W. Poolman, I. J.V. Kleinlugtenbelt, Alexander Marcus, Greg Merrell, Naquira Escobar Luis Felipe, Kimberlly S. Chhor, Jeffrey Yao, Lob Guenter, Parag Melvanki, Arie B. van Vugt, Francisco Lopez-Gonzalez, Craig Lomita, Saul Kaplan, Matt Mormino, Theresa O Wyrick, Gregory J. Della Rocca, C. Noel Henley, Edgardo Ramos Maza, Christopher B. Wall, Fred Baumgaertel, Roger P. van Riet, Sebastian Rodriguez-Elizalde, Stuart M. Hilliard, George S. Athwal, Peter V. Giannoudis, Angela A. Wang, Tamir Pritsch, John A. McAuliffe, Robert J. Feibel, Timothy Omara, Paul Levin, Jonathan Rosenfeld, Michael J. Prayson, Mark E. Baratz, R. Bryan Benafield, Christian Perrotto, George L. Thomas, Punita V. Solanki, George M. Kontakis, Robert Wagenmakers, Charles A. Goldfarb, Andrew H. Schmidt, Abhay Shrivastava, Mark D. Lazarus, Frederico C M Vallim, L. Marsh, Keith A. Segalman, H. Goost, Peter R. Brink, Michael W. Grafe, Jonathan P. Braman, April D. Armstrong, Charles Cornell, Thomas A. DeCoster, Daphne M. Beingessner, Neal C. Chen, Charalampos Zalavras, M. A J Van De Sande, Jennifer L. Giuffre, Thuan V. Ly, Georg M. Huemer, Vani J. Sabesan, Rodrigo Pesantez, Kevin Eng, A. Lee Osterman, Darren S. Drosdowech, Michael Moskal, B. Van Den, Nigel Rossiter, Michael Baumgaertner, Christian Heiss, James F. Kellam, P. C. Fuchs, Matej Kastelec, David J. Hak, Karel Chivers, Amy L. Ladd, Reid A. Abrams, Bob Arciero, Russell Shatford, Toni M. McLaurin, George S.M. Dyer, Ralph M. Costanzo, Frank L. Walter, Craig M. Torosian, Koroush Kabir, Timothy G. Havenhill, Brian L. Badman, Joachim P. Overbeck, Charles Metzger, Vishwanath M. Iyer, Annette K B Wikerøy, Carlos Henrique Fernandes, Jay Pomerance, Patrick T. McCulloch, Megan M. Wood, Richard Jenkinson, Brian J. Cross, Christos Garnavos, Marcus Lehnhardt, Ashok K. Shyam, Michael LeCroy, Abhijeet L. Wahegaonkar, Carrie R. Swigart, Lisa Taitsman, Vasileios S. Nikolaou, Gerald R. Williams, J. H. Peters, Sergio Rowinski, William Dias Belangero, Ibrahim Ibrahim, Jeremy A. Hall, Charles Cassidy, Mahmoud I. Abdel-Ghany, Michiel G.J.S. Hageman, M. Jason Palmer, Joseph P A M Vroemen, Frank J. P. Beeres, Alberto Pérez Castillo, Gustavo Borges Laurindo De Azevedo, Martin Richardson, Wolfgang Baer, Shep Hurwit, J. V. Clarke, Robert Tashijan, Scott F. M. Duncan, Thierry G. Guitton, Steven J. Rhemrev, J. Wolkenfelt, Richard Wallensten, Neil Saran, Brett D. Crist, J. Carel Goslings, Qiugen Wang, Francisco Javier Aguilar Sierra, Leonardo Alves De Mendonca, Paula M. Hasenboehler, Sanjeev Kakar, Grant E. Garrigues, Leonardo Rocha, Joel Murachovsky, Vidyadhar Telang, Edward J. Harvey, Richard Buckley, Jose A. Ortiz, Schandelmaier, Edward K. Rodriguez, Konul Erol, H. J. Helling, Nikolaos K. Kanakaris, Jeffry T. Watson, Desirae M. McKee, Graduate School, Orthopedic Surgery and Sports Medicine, AMS - Amsterdam Movement Sciences, Surgery, Other Research, and Other departments

Subjects
Male, medicine.medical_specialty, Decision Making, Alternative medicine, Likert scale, medicine, Humans, Orthopedics and Sports Medicine, Somewhat Important, Reimbursement, Social influence, Evidence-Based Medicine, business.industry, Mentors, Perspective (graphical), Evidence-based medicine, Hand, Surgery, Orthopedics, Family medicine, Practice Guidelines as Topic, Female, Clinical Competence, business, Null hypothesis
Abstract

Purpose To address the factors that surgeons use to decide between 2 options for treatment when the evidence is inconclusive. Methods We tested the null hypothesis that the factors surgeons use do not vary by training, demographics, and practice. A total of 337 surgeons rated the importance of 7 factors when deciding between treatment and following the natural history of the disease and 12 factors when deciding between 2 operative treatments using a 5-point Likert scale between "very important" and "very unimportant." Results According to the percentages of statements rated very important or somewhat important, the most popular factors influencing recommendations when evidence is inconclusive between treatment and following the natural course of the illness were "works in my hands," "familiarity with the treatment," and "what my mentor taught me." The most important factors when evidence shows no difference between 2 surgeries were "fewer complications," "quicker recovery," "burns fewer bridges," "works in my hands" and "familiarity with the procedure." Europeans rated "works in my hands" and "cheapest/most resourceful" of significantly greater importance and "what others are doing," "highest reimbursement," and "shorter procedure" of significantly lower importance than surgeons in the United States. Observers with fewer than 10 years in independent practice rated "what my mentor taught me," "what others are doing" and "highest reimbursement" of significantly lower importance compared to observers with 10 or more years in independent practice. Conclusions Surgeons deciding between 2 treatment options, when the evidence is inconclusive, fall back to factors that relate to their perspective and reflect their culture and circumstances, more so than factors related to the patient's perspective, although this may be different for younger surgeons. Clinical relevance Hand surgeons might benefit from consensus fallback preferences when evidence is inconclusive. It is possible that falling back to personal comfort makes us vulnerable to unhelpful commercial and societal influences.

Published
2013

7. Pneumococcal Meningitis in Children: Prognostic Indicators and Outcome

Author

C. M. L. Westerbeek, Herman J. Neijens, B. van der Heijde, Lodewijk Spanjaard, René F. Kornelisse, R. de Groot, A. B. Spoor, and Other departments

Subjects
Male, Microbiology (medical), medicine.medical_specialty, Pediatrics, CSF glucose, medicine.disease_cause, Epidemiology, Streptococcus pneumoniae, medicine, Humans, Serotyping, Child, Survival analysis, Neurologic Examination, Coma, Respiratory distress, Meningitis, Pneumococcal, business.industry, Mortality rate, Age Factors, Infant, Newborn, Infant, Prognosis, medicine.disease, Survival Analysis, Surgery, Causality, Infectious Diseases, Child, Preschool, Female, medicine.symptom, business, Meningitis
Abstract

We studied the outcome of pneumococcal meningitis in 83 children who were admitted to a referral hospital and whose meningitis was diagnosed between 1970 and 1994. The median age of the children was 8 months. The most frequently isolated capsular serotypes and/or serogroups of Streptococcus pneumoniae were 6, 14, 18, 19, and 23. Twenty-nine children (35%) were referred by other hospitals. A mortality rate of 17% (primary referrals, 7%; secondary referrals, 35%) was observed. At discharge, 25 survivors (36%) had sequelae: hearing loss (> or = 30 dB) in 19% and neurological sequelae in 25%. During admission, the presence of coma, respiratory distress, shock, a cerebrospinal fluid (CSF) protein level of > or = 2.5 g/L, a peripheral white blood cell count of < 5 x 10(9)/L, and a serum sodium level of < 135 mmol/L were associated with mortality. Sequelae were associated with the presence of coma and a CSF glucose level of < 0.6 mmol/L. We conclude that the mortality rate of pneumococcal meningitis is lower among children than among adults. Children often die of neurological sequelae, while adults frequently die of cardiorespiratory failure due to underlying diseases. For children, coma, respiratory distress, and shock during admission were the clinical findings with the strongest predictive value for sequelae or death.

Published
1995
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