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OBJECTIVE: To determine the use and barriers to uptake of a surgical safety checklist (SSC) after implementation in a veterinary teaching hospital. STUDY DESIGN: Voluntary online survey and retrospective study. SAMPLE POPULATION: All personnel actively involved in the Ontario Veterinary College Health Sciences Centre small animal surgery service between October 2, 2018 and June 28, 2019. METHODS: Surgical case logs and electronically initiated SSC were reviewed to calculate checklist use. The sample population was surveyed to identify factors and barriers associated with use of the SSC. Participants were allowed 1 month to respond, and five reminder emails were sent. RESULTS: Forth‐one of 50 (82%) participants completed the survey. The SSC was used in 374 of 784 (47.7%) surgeries. Use rates declined over sequential three‐month intervals (P

Etat de la question L’objectif etait de developper un questionnaire mesurant les poussees dans l’arthrose et evaluer ses proprietes psychometriques. Materiel et methodes Les items ont ete generes a partir d’entretiens semi-structures et d’un groupe de discussion (patients, cliniciens) en utilisant une approche bilingue. La selection des items a ete faite avec une methode Delphi. Des patients arthrosiques en Australie, en France et aux Etats-Unis ont rempli les questionnaires electroniques. L’analyse factorielle et l’approche du contenu ont ete utilisees pour reduire les items et determiner la validite structurelle. Le questionnaire obtenu (score de 0 a 100) a ete teste pour la coherence interne, la validite convergente et discriminante. Resultats Depuis les 180 items initialement generes, la methode Delphi et comites d’experts ont selectionne 33 items. Le questionnaire comportait cinq domaines et utilisait les modalites de reponse (0 = Pas du tout a 10 = Absolument). Parmi les 398 patients (âge moyen 64 ans) ayant rempli le questionnaire, 70,4 % etaient des femmes et 86,7 % avait une arthrose du genou. L’analyse factorielle confirmatoire retenait un modele a 19 items (RMSEA = 0,06 ; SRMR = 0,04 ; CFI = 0,96 et TLI = 0,94). L’alpha de Cronbach etait > 0,9 pour les cinq domaines et l’ensemble du questionnaire. La correlation entre Flare-OA et les autres instruments etaient conformes aux previsions. La difference de score (31,8) entre les patients avec et sans poussee etait significative (p Conclusion Flare-OA est un instrument valide et fiable, rapporte par les patients atteints d’arthrose du genou/hanche, qui permet d’evaluer la frequence et la gravite des poussees d’arthrose en recherche clinique ( Tableau 1 , Tableau 2 , Tableau 3 ).

Ability to assess flares in osteoarthritis (OA) of the knee and hip (KHOA) is important in clinical care and research. Using mixed methods, we developed a self-reported instrument measuring flare and assessed its psychometric properties.We constructed questionnaire items from semi-structured interviews and a focus group (patients, clinicians) by using a dual-language (English-French) approach. A Delphi consensus method was used to select the most relevant items. Patients with OA from Australia, France and the United States completed the preliminary Flare-OA, HOOS, KOOS and Mini-OAKHQOL questionnaires online. We used a factor analysis and content approach to reduce items and determine structural validity. We tested the resulting questionnaire (score 0-100) for internal consistency, convergent and known-groups validity.Initially, 180 statements were generated and reduced to 33 items in five domains (response 0 = not at all, to 10 = absolutely) by Delphi consensus (50 patients, 116 professionals) and an expert meeting. After 398 patients (mean [SD] age 64 [8.5] years, 70.4% female, 86.7% knee OA) completed the questionnaire, it was reduced to 19 items by factor analysis and a content approach (RMSEA = 0.06; CFI = 0.96; TLI = 0.94). The Cronbach's alpha was0.9 for the five domains and the whole questionnaire. Correlation coefficients between Flare-OA and other instrument scores were as predicted, supporting construct validity. The difference in Flare-OA score between patients with and without flare (31.8) largely exceeded 2 SEM (10.2).Flare-OA is a valid and reliable patient-reported instrument for assessing the occurrence and severity of flare in patients with KHOA in clinical research.

This study compared population hip fracture rates for women with a prior fragility fracture who were treated with first-generation versus second-generation bisphosphonate therapies. The observational study found that, relative to women treated with etidronate, a first-generation bisphosphonate, women treated with the second-generation therapies ‘alendronate’ or ‘risedronate’ were equally likely to be admitted to hospital for hip fracture. Our findings must be confirmed in large randomized head-to-head controlled trials. Few studies have examined hip fracture outcomes among users of first- versus second-generation bisphosphonates. We compared hip fracture rates among elderly women with a history of fracture dispensed first- and second-generation bisphosphonates, hypothesizing that hip fracture rates would be higher among users of first- versus second-generation bisphosphonates after adjusting for confounders. Administrative data from Ontario, Canada from 01 April 1998 to 31 March 2002 was used to identify population-based bisphosphonate-naive cohorts of subjects age 66 years and older initiated on first- (etidronate plus calcium; n = 19,127) or second-generation (alendronate or risedronate; n = 1,460) bisphosphonates. Multivariate Cox proportional hazard models were used for analysis. During over 23,000 person-years of follow-up, we observed 293 hospital admissions for first hip fracture. The unadjusted event rates yielded approximately 12.5 hospital admissions for hip fracture per 1,000 person-years of follow-up in each study group. Relative to the etidronate plus calcium group, females in the alendronate or risedronate group were equally likely to be admitted for hip fracture (adjusted rate ratio [aRR] = 1.0; 95% CI 0.6–1.6). The findings of this study suggest similar rates of hip fracture between the first- and second-generation bisphosphonates when used continuously among elderly females with a prior history of fracture.

A simple mechanical design for quadrupedal locomotion, termed SCOUT, is proposed, featuring only one degree of freedom per leg. The paper demonstrates experimentally that our first prototype SCOUT-1 is capable of walking, turning, and climbing over a step, despite its mechanical simplicity. The underlying principle is dynamic operation, based on controlled momentum transfer. Simulations show successful walking, stair climbing and running.

A locking, unactuated knee is added to the Scout II quadruped robot and trotting gaits are studied. The mechanical design of the knee is presented, trotting algorithms are discussed, and a control approach for a robotic leg with an unactuated knee is developed. A model of a single leg is used to determine appropriate leg trajectory parameters and initial conditions to achieve trots. The single leg system and the complete robot are simulated. Experimental implementation of single leg control and quadruped trotting on Scout II are presented.

The purpose of this study was to establish population values for hip function for patients of different ages using the validated WOMAC scoring system and the traditional Harris hip scoring system. A random sample of 184 individuals who had no prior history of hip or knee pain or pathology was evaluated. The average WOMAC scores for pain, function, and stiffness were 0.01, 1.8, and 0.4. The average Harris hip score was 94 +/- 8.2. No significant correlation was noted between the summary WOMAC score, the WOMAC stiffness or pain subscales, or the overall Harris hip score for any of the 3 age groups studied. Patients with complaints in other joints, such as the back and neck, had lower WOMAC and Harris hip scores. Adults who are healthy and do not have a prior history of hip or knee pathology do not show a significant decline in hip function as they grow older. A deterioration in the function of a total hip arthroplasty over time cannot be attributed solely to the aging process.

Many patients who have undiagnosed osteoporosis and a recent fragility fracture present to fracture clinics in Canadian hospitals, where the focus of management is on fracture care. The rate of diagnosis and treatment of osteoporosis in this patient group is unknown.Patients who presented with fractures at sites consistent with fragility-type fractures were identified through a retrospective chart review of fracture clinic visits in 3 Ontario community hospitals in selected weeks in February and November 1996 and August and May 1997. These patients were contacted by mail and telephone follow-up to obtain consent to participate in a telephone interview. Patients were excluded if the index fracture had been traumatic, if they were younger than 18 years, or if they had medical conditions known to be associated with secondary bone loss. Eligible patients were questioned about their history of prior fractures, diagnosis of osteoporosis, and investigation and treatment of osteoporosis before or after the index fracture.Among 2694 fracture clinic visits, we identified 228 patients (8.4%) with fragility-type fractures. Of the 228, 128 (56.1%) were contacted and agreed to participate in an interview about 1 year from the date of the index fracture. Of the 128 patients, 108 (83 postmenopausal and 13 premenopausal women and 12 men) were confirmed as eligible. Of the 108, 43 had experienced 53 fractures in addition to the index fracture in the preceding 10 years, of which 71% were of the fragility type. At interview, only 20 (18.5%) (all postmenopausal women) of the 108 patients reported that they had received a diagnosis of osteoporosis. Of the 20, 90% and 45% respectively had been advised to take calcium and vitamin D supplements; 8 (40%) were receiving hormone replacement therapy (HRT), and 8 (40%) were taking bisphosphonates. Of the 88 patients who had not received a diagnosis of osteoporosis, 4 (4.5%) were receiving HRT, none was taking bisphosphonates, and less than 20% had been advised to take supplemental calcium or vitamin D.In a representative sample of patients at urban fracture clinics, less than 20% who presented with a fragility-type fracture had undergone investigation and adequate treatment of osteoporosis at 1-year follow-up. Since previous fracture significantly increases the risk for future fracture, this clearly is a deficiency in management. Through improved identification and treatment of patients with osteoporosis-related fractures who present to fracture clinics, there is a significant opportunity to reduce the rates of illness and death associated with this condition.

A cross-sectional, community-based survey of a random sample of 1750 of 242,311 Medicare recipients was performed. The patients were at least sixty-five years old and had had a primary or revision knee replacement (either unilaterally or bilaterally) between 1985 and 1989. Three samples were surveyed separately: a national sample (to reflect the United States as a whole) and samples from Indiana and the western part of Pennsylvania (sites chosen for convenience to assess the validity of the findings for the national sample on a regional level). Each sample was stratified by race, age, residence (urban or rural), and the year of the procedure. Valid and reliable questionnaires were used to elicit the participants' assessments of pain, physical function, and satisfaction two to seven years after the knee replacement. Of the 1486 patients who were eligible for inclusion in the survey, 1193 (80.3 per cent) responded. The mean age of the respondents was 72.6 years. Eight hundred and forty-nine respondents (71.2 per cent) were white, and 849 (71.2 per cent) were women. The participants reported that they had little or no pain in the knee at the time of the survey, regardless of the age at the time of the knee replacement, the body-mass index, or the length of time since the knee replacement. After adjustment for potential confounding variables, predictors of better physical function after the replacement were an absence of problems with the contralateral knee, primary knee replacement (rather than revision) (Indiana sample only), and a lower body-mass index (Indiana and western Pennsylvania samples). Four hundred and fifteen (85.2 per cent) of the 487 patients in the national sample were satisfied with the result of the knee replacement. In what we believe to be the first community-based study of the outcome of knee replacement, patients reported having significant (p = 0.0001) and persistent relief of pain, improved physical function, and satisfaction with the result two to seven years postoperatively. The findings of the present study suggest that age and obesity do not have a negative impact on patient-relevant outcomes (pain and physical function). Dissemination of these findings has the potential to increase appropriate referrals for knee replacement and thereby reduce the pain and functional disability due to osteoarthrosis of the knee.

To determine the relationship between regional variations in knee replacement (KR) utilization rates in Ontario, Canada, and the reported prevalence of arthritis and rheumatism as a chronic health problem.Utilization data were acquired from the Canadian Institute for Health Information for KR procedures performed in Ontario between fiscal years 1984 and 1990. Census information was obtained from Statistics Canada. Disease prevalence data were derived from the 1990 Ontario Health Survey (OHS). Public Health Units (PHU) were used as the unit of analysis, with utilization rates defined as the number of KR performed on all PHU residents (irrespective of where these procedures were performed) divided by the population. Direct methods were used to standardize utilization for age, sex, and disease prevalence. The extremal quotient, the weighted coefficient of variation, and the systematic component of variation were used as measures of variation. The relationship between the number of KR performed in each age-sex-year strata and various demographic (age and sex), disease prevalence, and regional dummy variables was estimated using a Poisson regression model.Regional variation in the standardized utilization of KR surgery was wide, but declined over the study period; the extremal quotient fell from 8.0 to 3.3, the weighted coefficient of variation fell from 0.49 to 0.30, and the systematic component of variation fell from 0.20 to 0.17. Variation in the provision of KR surgery remained even after controlling for the demographic composition of the population and disease prevalence. Moreover, while demographic, regional, and temporal covariates were significant (p0.0001) in accounting for over 90% of the variation in utilization, disease prevalence was not significant (p0.05).This study merged population based reports of disease prevalence with administrative data to account for regional variations in utilization. While regional variations in KR surgery have fallen over time, variations remain even after adjusting for patient reported disease prevalence. The finding that demographic variables and the reported prevalence of disease were poorly correlated suggests that current area variation studies may not be adjusting fully for disease prevalence or severity.

To clarify examine the epidemiologic evidence linking work related exposure to osteoarthritis (OA) of the hip and knee.We investigated MEDLINE and EMBASE 1966-1994 with search terms of osteoarthritis, osteoarthrosis, arthrosis; risk factors, exposure; occupational diseases, agricultural workers' diseases, work. From 123 original studies on risk factors for OA, 17 studies were identified as providing a comparison group and relating the presence or absence of radiologically diagnosed OA to occupational factors. The quality of the methodology of each study was evaluated independently by 4 reviewers using a standardized protocol.Common methodological problems were encountered in areas such as representatives, recall of exposure, and evaluation of exposure and outcome. These problems often made a cause-effect relationship difficult to interpret. However, 7 of the 17 studies met our criteria for good methodological quality. A critical analysis of their results led to the following conclusions: (1) A consistently positive relationship exists between work involving knee bending and knee OA in men (range of odds ratio: 1.4-6). (2) The evidence suggesting a relationship between knee OA and occupational exposure in women is inconclusive. (3) A consistently positive but weak relationship exists between work related exposure (i.e., farming in particular) and hip OA in men. We felt we could not conclude with confidence that this relationship is strong due to the potential biases that exist in each of these studies. (4) No study attempted to investigate occupational exposure and hip OA in women.Studies suggest a strong positive relationship between work related knee bending exposure and knee OA. The evidence between work related exposure, farming in particular, and hip OA is consistently positive but weak.

OBJECTIVE: To compare the appropriateness of case selection for primary hip and knee replacements between two regions in Ontario: one with a high population-based utilization rate and one with a low rate. DESIGN: Random audit of medical records sampled from hospital discharge abstracts, with subsequent implicit and explicit criteria-based assessments of the appropriateness of surgery. STUDY POPULATION: People aged 60 years or over who underwent elective, single-joint, non-fracture-related, primary hip or knee replacement between Apr. 1, 1992, and Mar. 31, 1993, at one of seven hospitals in a high-rate region (comprising Brant, Huron and Oxford countries) or one of eight hospitals in a low-rate region (comprising the cities of Scarborough and Toronto). INTERVENTIONS: Structured review of hospital medical records, with additional review of information from surgeons and family physicians' office charts if necessary. Three physicians reviewed patient data and rated the preoperative pain level and functional status of patients, with agreement among at least two reviewers. The proportion of inappropriate cases was then assessed according to explicit criteria defined by a multidisciplinary panel using the delphi process. Profiles of each case were also subjected to independent implicit review by two rheumatologists and two orthopedic surgeons. OUTCOME MEASURES: Proportion of joint replacements deemed inappropriate in the high- and low-rate regions according to either the explicit criteria or the implicit review, as well as preoperative pain levels and functional status of patients in the high- and low-rate regions. RESULTS: Hip replacements were more common among patients sampled in the low-rate region than among those in the high-rate region (57.3% v. 39.3%; p < 0.002), although the patients' baseline characteristics, including severity of preoperative pain and dysfunction, were otherwise similar between the regions. Inappropriate surgery, determined by explicit criteria, was equally uncommon in the two regions (6.4% and 6.1%). On implicit review, the two rheumatologists rated fewer cases as appropriate than did the two orthopedic surgeons (63.0% v. 80.0%; p < 0.001); however, the proportion of cases rated as inappropriate by the subspecialists was similar in the high- and low-rate regions (11.4% and 11.0%, respectively, by the rheumatologists, and 6.3% and 10.4%, respectively, by the orthopedic surgeons). CONCLUSIONS: Patients selected for primary hip or knee replacement are similar in the high- and low-rate regions of Ontario. Inappropriate use of this procedure does not account for the high rate of surgery in some areas. Further studies will be required to determine which other factors account for the regional variations in the utilization rates and whether there is underservicing in low-rate areas.

To measure regional variations in knee replacement (KR) utilization rates across the 49 counties of Ontario, Canada, since April 1, 1984, and to evaluate its relationship with the supply of health professionals.Utilization data were acquired from the Canadian Institute for Health Information, and physician data were acquired from the Ontario Ministry of Health. There were 18,530 hospitalizations for KR in Ontario between April 1, 1984 and March 31, 1991. Utilization rates were defined as the number of KR procedures for all residents of each county (irrespective of where these procedures were performed) divided by the resident population. Direct methods were used to standardize utilization for age and sex. The extremal quotient, the weighted coefficient of variation, and the systematic coefficient of variation were used as measures of variation.Between fiscal years 1984 and 1990, the extremal quotient fell from 8.1 to 3.4, the weighted coefficient of variation fell from 0.430 to 0.315, and the systematic coefficient of variation fell from 0.215 to 0.142. Utilization was greater in southwestern Ontario (p0.001) and lower in Toronto and Durham (p0.001) than elsewhere. Utilization in remote areas was not different from that for the province as a whole (p0.001). The correlation coefficient between standardized KR utilization and the density of orthopedic surgeons was not significant (p = 0.26) at -0.16, but those for rheumatologists (r = -0.25, p = 0.08) and physical medicine specialists (r = -0.42, p = 0.002) were significant.Regional variation in KR surgery has fallen since fiscal year 1984 from "very high" variability to "moderate" variability. KR utilization was shown to be negatively, but not significantly, related to orthopedic surgeon density. Therefore, proposals to modify surgeons' fees or to influence their practice locations may equalize the supply of surgeons, but are unlikely to affect the pattern of KR utilization.

OBJECTIVE. The aim of this study is to describe the practice variation of knee replacements (KRs) in the elderly ( > or = 65) over time from 1985-1990 in terms of the number of primary, bilateral, and revision KRs; the extent of large area variation in performance rates; and the degree to which demographic variables are the determinants of area rates. DATA SOURCES/STUDY SETTING. Data analyzed are from every hospital in the United States that performed a KR on a Medicare patient during the study period. Data were obtained from the MEDPAR, HISKEW, and denominator files of the Medicare Statistical System. STUDY DESIGN. This is a cohort study of all Medicare beneficiaries who received a KR between 1985 and 1990. The dependent variable in the analyses was the count of the KRs performed in each area. DATA COLLECTION/EXTRACTION METHODS. This is a population-based sample of Medicare enrollees in the United States. All hospitalizations for Medicare-reimbursed KRs were included in the initial data set. Exclusion criteria were used to identify the Medicare covered population with a definite KR. These criteria resulted in 7.3 percent exclusions and a final set of 414,079 KR hospitalizations. PRINCIPAL FINDINGS. The number of Medicare-funded KRs increased in each of the study years corresponding to an annual rate of increase of 18.45 percent. The likelihood of receiving a KR was a function of age, gender, and race. For each year, KRs were almost-twice as likely to be performed on women than on men. The odds of whites getting the surgery were over 1.5 times greater than for blacks. Even after adjusting for demographic factors, significant regional variation remained. CONCLUSIONS. Much about area variation and the rate of growth in KR rates remains unexplained. For answers to emerge, better data and different types of studies are required.

To assess agreement among rheumatologists and family physicians (FP) about the indications for knee replacement (KR) referral, use of nonsurgical management options, and perceived outcomes of KR, and to determine the relationship between these opinions and the number of patients seen with severe osteoarthritis (OA) of the knee.98 adult rheumatologists and a random sample of 250 FP in Ontario, Canada were surveyed. Of the practising and traceable rheumatologists and FP, 70.0 and 5.16% responded, respectively.FP disagreed on how 28 of 32 patient factors affected their KR referral decision, while rheumatologists disagreed on 26 of these 32 factors (p = 0.03). Rheumatologists and FP consistently disagreed on the use of 8 of 10 treatments for knee OA (p = 0.37). While rheumatologists and FP reported similar KR outcomes, FP were less in agreement (p = 0.03). Clinical disagreement for the indications for KR (p0.0001) and KR outcomes (p0.0001) were greater among FP than among orthopedic surgeons who were surveyed in a prior study. Clinical disagreement about the indications for KR was greater among rheumatologists than among surgeons (p = 0.04), but there was no difference in perceived KR incomes (p = 0.18).Referring physicians disagreed on the indications for KR referral an on the treatments for knee arthritis, but were in general agreement regarding KR outcomes. Clinical disagreement was greater among FP than among rheumatologists, who in turn reported more disagreement than orthopedic surgeons. Explanations for these difference in perceptions should be the focus of research, but guidelines specifically tailored for each physician specialty may be required to reduce clinical uncertainty.

This study determined the temporal trends and factors associated with the rates of performance of tibial osteotomies from 1985 to 1990 in Ontario, Canada and the United States. The Health Care Financing Administration, Ontario Health Insurance Plan, and National Hospital Discharge Survey databases were used to determine the number of osteotomies from 1985 to 1990. Osteotomy rates decreased in both countries approximately by 11% to 14% per year in patients 65 years and older and by 3% to 4% per year in patients younger than 65 years. Men received twice as many osteotomies as women in both countries. In the United States, the average rate of tibial osteotomies was 2 to 3 times lower than in Ontario.

The discriminant validity of a generic, health related quality of life (HRQL) measure, the SF-36, was compared with that of a disease specific HRQL measure, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), in patients aged 67-99 years who had undergone knee replacement surgery 2 to 7 years previously.A stratified random sample of 1750 Medicare beneficiaries was surveyed and 1193 usable responses were obtained (after adjustment for ineligible, incapacitated, and deceased individuals). Discriminant validity of scale scores common to both instruments (pain, physical functioning, and overall score) were compared.Examination of discriminant validity, using Spearman correlations, showed that the WOMAC discriminates better among individuals with knee problems, while the SF-36 discriminates better among individuals with varying levels of self reported general health status and comorbidities.These scales measure 2 distinct but important aspects of patients' health. These results support inclusion of both a generic and a disease specific HRQL measure in cross sectional studies.

Generic and disease-specific health status instruments are commonly used to assess patients' outcomes. The hypothesis that they measure distinct but complementary aspects of patients' quality of life was tested using a sample of patients aged 67 to 99 years who had undergone knee replacement surgery 2 to 7 years previously. Patients' scores on a generic health-related quality-of-life (HRQOL) measure, the SF-36, were compared to those of the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index; the WOMAC was developed specifically for patients with lower extremity arthritis, whereas the SF-36 is aimed at all conditions. A stratified sample of 1,750 Medicare beneficiaries was surveyed and an overall response rate of 80.3% achieved, resulting in 1,193 usable surveys (after adjustment for ineligible, incapacitated, and deceased individuals). The distribution of scores on the three dimensions common to both instruments (i.e., pain, physical function, and overall score) showed consistently higher scores on the WOMAC, on a scale of 0 (worst) to 100 (best), than on the SF-36, indicating less disability from arthritis than from other conditions after knee surgery in this elderly population. Statistically significant differences in the number of people with perfectly healthy scores were detected between the instruments; with regard to pain, 32.2% of the sample reported no pain due to arthritis on the WOMAC, compared with only 13.6% reporting no pain due to any conditions on the SF-36. The figures for physical function and overall score were 9.6% versus 1.4%, and 6.9% versus 0.2%, respectively. Examination for discriminant validity showed that the scores on the two scales followed hypothesized patterns: the WOMAC discriminated better among subjects with varying severity of knee problems, whereas the SF-36 discriminated better among subjects with varying levels of self-reported health status and comorbidity. The results of this study support the inclusion of both a generic and a disease-specific HRQOL measure to assess patient outcomes fully.

To determine waiting times for an initial orthopedic consultation and subsequent knee replacement surgery in Ontario and patients' acceptance of these waiting times.Mailed patient survey to 185 randomly selected knee replacement recipients discharged from 5 Ontario hospitals between 1985 and 1990, with telephone followup after 2 mailings, implemented between May and July, 1992. Patients were asked about waiting times for their initial orthopedic consultation and subsequent knee replacement surgery and their acceptance of these waiting times.Of the 185 patients, 40 were excluded because they were deceased, unable to respond, or not traceable. Of the 145 eligible patients, 127 or 87.6% responded. The median waiting times for an initial consultation and for knee replacement surgery were 4.0 and 9.5 weeks, respectively. Waiting times did not change significantly over the 5-year study period (Pearson correlation coefficients: 0.07, p = 0.53, for consultation, and -0.08, p = 0.44, for surgery). The waiting times for consultation and surgery were acceptable to 93.2% (95% confidence interval: 88.7-97.7%) and 88.1% (95% confidence interval: 82.3-93.9%) of respondents, respectively. The average acceptable surgical waiting time of 13.2 weeks was significantly shorter than the not acceptable average of 34.3 weeks (p0.001).The average waiting periods for an initial orthopedic consultation and subsequent knee replacement surgery were relatively short, and the majority of patients considered their waiting times acceptable.

SLEDAI, a disease activity index for systemic lupus erythematosus (SLE) has been validated against other such indices and its reliability has been shown by specialists in SLE. To assess its reliability among less experienced clinicians, we conducted a reliability study with 3 rheumatology trainees and 9 patients with SLE according to a Latin square design. SLEDAI easily distinguished between patients (p = 0.0009), and physician variability was not statistically significant (p = 0.27). Inter and intraobserver agreement were 78.7 and 98.0%, respectively. SLEDAI was thus shown to be a reliable instrument among less experienced observers for the assessment of disease activity in SLE.

681 Background: A prospective case-control study was carried out on 425 women treated for breast cancer who survived for 10 years without evidence of recurrence (cases) matched for age, race and length of follow-up from diagnosis to 425 women with benign breast disease followed for 10 or more years (controls). For cases, only 23% received chemotherapy and 33% hormone therapy. Methods: We examined multiple indicators of physical and emotional well-being and report here the results pertaining to cardiac and bone health. Bone mineral density (BMD) was assessed using DXA at the lumbar spine and hip, expressed as gm/cm2, and classified as normal/low bone mass/osteoporosis. Cardiac health was assessed using 10 year cardiovascular risk, calculated as low, moderate or high based on age, cholesterol and triglyceride levels, smoking history and blood pressure (according to the calculation published by Genest J et al. CMAJ 2003). Treatment received for both bone and cardiac disease was evaluated. The comparison of cases and controls was assessed using the Wilcoxon non-parametric or Chi-squared tests. Results: Body mass index (BMI) was significantly greater for cases versus controls (27.5 ± 2.4 vs 26.7 ± 4.9; p = 0.034). The mean BMD (corrected for weight) was 1.08 ± 0.05 g/cm2 at the spine for cases, compared with 1.11 ± 0.06 g/cm2 for controls (p No significant financial relationships to disclose.

8010 Background: We sought to clarify the long-term side effects of treatment and quality of life (QOL) of breast cancer survivors. Methods: We conducted a case-control study of survivors, ≤ 10 years disease-free since diagnosis, matched to women with benign breast disease for age, years followed, and demographic profile. Data was collected for routine blood tests, lipids, bone mineral density (BMD), exercise step test, HRT use, vitamin and alternative medication (AM) use, arm strength and measurements, health history, and for survivors, breast cancer demographics. QOL instruments included EORTC QLQ-C30, SF36, and QOL-CS. Results: N = 850, 425 cases, 425 controls. For cases, average tumour size was 2.2 cm, 57% ER +, 40% PR +. 93.8% had axillary nodal dissection, 24.1% had positive nodes, median of 11.8 nodes removed, median of 1 positive. 59.7% had lumpectomy, 50.8% radiotherapy, 33% tamoxifen, 4.9% ovarian ablation, 22.8% chemotherapy, and 13% breast reconstruction. Cases had significantly more pack year...

SUMMARYBare-patches (Bpa), a semi-dominant, sex-linked, male-lethal gene in the mouse is described. It shows 14·5 ± 3·0% recombination with Blo and 5·4 ± 2·2 % with Ta and may, therefore, be allelic with Str.Only about half the expected number of heterozygous females is observed; the remainder appear to lose their mutant chromosome and become XO females as there is an excess of non-Bpa females, at least 24% of which proved to be XO. It is not yet certain whether the lost X chromosome is always the mutant one nor is it certain whether the loss is a property of the Bpa gene or due to a closely linked factor: a separate factor seems more likely. Some possible mechanisms for XO production are discussed.

Dectra (Decca Track/Range) is one of two British systems recommended at the March 1954. meeting of Com. Division of I.C.A.O. in Montreal for evaluation by interested States. Arrangements are now being made to commence proving trials of Dectra at the end of this year or possibly the beginning of 1957. The trials will be made under the auspices of the Ministry of Supply and Ministry of Transport and Civil Aviation in this country and with the support of the Department of Transport in Newfoundland. The system is primarily designed for the navigation of fast jet aircraft across the North Atlantic, a problem intensified by air traffic control when more than 100 aircraft are in the air at the same time on those routes. It is, however, likely to prove valuable for other similar applications. The trials installation will cover the main route Prestwick–Gander.

SUMMARYLifetime reproductive performance was studied in 50 sib-pairs of female mice, one member of each pair chromosomally XX and the other XO. Twenty-five pairs were irradiated with 25 rad X-rays at 10 days of age and 25 were unirradiated. In both the irradiated and control series the XO mice had a significantly shorter reproductive life than the XX ones, but unirradiated XO bred longer than irradiated XX. The median age of unirradiated XO at birth of last litter was 280 days and they had 6·5 ± 0·80 litters, whereas for XX the figures were 420days and 12·6 ± 0·74. The mean litter-size of XO mice was only about 55% and their lifetime productivity 34% of that of their XX sibs. Similarly, the lifetime productivity of irradiated XX females was only 31% of that of unirradiated XX. Histological studies showed that in the unirradiated XO mice reproduction ended through shortage of oocytes, and the resulting secondary ovarian changes were similar to those in irradiated mice. Thus, the differences between human and mouse XO types are to some extent reconciled. Both become sterile through death of oocytes, in humans before puberty and in mice after. This difference may be connected with different times from oogenesis to puberty in the two species.