The Ellipse modification of the Friedman method for measuring glenoid version

2020 ◽  
Vol 102-B (2) ◽  
pp. 232-238
Author(s):  
Saqib Javed ◽  
Saif Hadi ◽  
Mohamed A. Imam ◽  
Dimitris Gerogiannis ◽  
Philip Foden ◽  
...  
Keyword(s):  
Total Shoulder Arthroplasty ◽  
Poor Agreement ◽  
Glenoid Version ◽  
Limits Of Agreement ◽  
Altman Plot ◽  
Ellipse Method ◽  
Friedman Method ◽  
The Mean ◽  
The Difference ◽  
Clinically Significant

Aims Accurate measurement of the glenoid version is important in performing total shoulder arthroplasty (TSA). Our aim was to evaluate the Ellipse method, which involves formally defining the vertical mid-point of the glenoid prior to measuring the glenoid version and comparing it with the ‘classic’ Friedman method. Methods This was a retrospective study which evaluated 100 CT scans for patients who underwent a primary TSA. The glenoid version was measured using the Friedman and Ellipse methods by two senior observers. Statistical analyses were performed using the paired t-test for significance and the Bland-Altman plot for agreement. Results The mean glenoid version was -3.11° (-23.8° to 17.9°) using the Friedman method and -1.95° (-29.8° to 24.6°) using the Ellipse method (p = 0.002). In 16 patients the difference between methods was greater than 5°, which we considered to be clinically significant. There was poor agreement between methods with relatively large 95% limits of agreement. There was excellent inter-rater agreement between the observers for the Ellipse method and similarly, the intrarater agreement was excellent with a repeatability coefficient of 0.94. Conclusion We recommend the use of the Ellipse modification to define the mid glenoid point prior to measuring the glenoid version in patients undergoing TSA. Cite this article: Bone Joint J 2020;102-B(2):232–238.

Inter- and intra-operator variability associated with extracapsular suture tensioning

2012 ◽  
Vol 25 (06) ◽  
pp. 472-477 ◽  
Author(s):  
E. A. Buffa ◽  
A. M. Marchevsky ◽  
J. Heller ◽  
A. P. Moores ◽  
M. Farrell ◽  
...  
Keyword(s):  
Ex Vivo ◽  
Cruciate Ligament ◽  
Mean Difference ◽  
Marked Variation ◽  
Limits Of Agreement ◽  
Cranial Cruciate Ligament ◽  
Suture Tension ◽  
Clinical Consequences ◽  
The Mean ◽  
The Difference

SummaryObjectives: To determine inter- and intra- operator variability associated with extracapsular suture tensioning as performed during lateral fabello-tibial suture placement.Study design: Ex vivo study.Methods: Fifteen Greyhound cadaveric pelvic limbs were prepared by cutting the cranial cruciate ligament and placing an extracapsular fabello-tibial suture. On two occasions, three surgeons tensioned the extracapsular suture of each stifle. Stifles were returned to 135 degrees of flexion and the suture tension was measured using a commercially available suture tensioner with inbuilt tensiometer.Statistical analysis: Intra-operator and inter-operator agreement were assessed using the limits of agreement method. A linear mixed effects model was specified to assess the effect of operator, repeated estimates and stifle order on tension applied.Results: The mean difference within the three operators ranged from 0 to 14.7N. With 95% limits of agreement, on most occasions for all three operators, the difference was between –31.7 and 41.0 N. The mean difference between the three operators ranged from 6.0 to 30.7 N. With 95% limits of agreement, on most occasions the difference between operators was between –25.6 and 62.5 N.Clinical significance: Marked variation exists in the tension applied during fabello- tibial suture application, both within and between surgeons. This variation may lead to inconsistent clinical outcomes. Further studies are required to determine the clinical consequences of this marked variation in extracapsular suture tensioning.

scholarly journals Time to adapt in the pandemic era: A prospective randomized non–inferiority  study comparing time to intubate  with and without  the barrier box

2020 ◽  
Author(s):  
Praneeth Madabhushi ◽  
Sudhakar Kinthala ◽  
Abistanand Ankam ◽  
Nitin Chopra ◽  
Burdett Porter
Keyword(s):  
Management Practices ◽  
Controlled Trial ◽  
Peripheral Nerve Stimulator ◽  
Secondary Endpoints ◽  
The Mean ◽  
The Difference ◽  
Clinically Significant ◽  
Induction Times ◽  
End Tidal ◽  
Bag Mask Ventilation

Abstract Background The challenges posed by the spread of COVID-19 disease through aerosols have compelled anesthesiologists to modify their airway management practices. Devices such as barrier boxes are being considered as potential adjuncts to full PPE's to limit the aerosol spread. Usage of the barrier box raises concerns of delay in time to intubate (TTI). We designed our study to determine if using a barrier box with glidescope delays TTI within acceptable parameters to make relevant clinical conclusions.Methods 78 patients were enrolled in this prospective non inferiority controlled trial and were randomly allocated to group C (without the barrier box) or the study group BB (using barrier box). The primary measured endpoint is time to intubate (TTI), which is defined as time taken from loss of twitches confirmed with a peripheral nerve stimulator to confirmation of end-tidal CO 2. 15 seconds was used as non-inferiority margin for the purpose of the study .We used an unpaired two-sample single-sided t-test to test our non- inferiority hypothesis (H 0 : Mean TTI diff ≥ 15 seconds, H A : Mean TTI diff < 15 seconds). Secondary endpoints include the number of attempts at intubation, lowest oxygen saturation during induction, and the need for bag-mask ventilation.Results Mean TTI in group C was 42 (CI 19.2 to 64.8) seconds vs. 52.1 (CI 26.1 to 78) seconds in group BB. The difference in mean TTI was 10.1 seconds (CI -∞ to 14.9). We rejected the null hypothesis and concluded with 95% confidence that the difference of the mean TTI between the groups is less than < 15 seconds (95% CI -∞ to 14.9,p = 0.0461). Our induction times were comparable (67.7 vs. 65.9 seconds).100% of our patients were intubated on the first attempt in both groups. None of our patients needed rescue breaths.Conclusions We conclude that in patients with normal airway exam, scheduled for elective surgeries, our barrier box did not cause any clinically significant delay in TTI when airway manipulation is performed by well-trained providers.The study was retrospectively registered at clinicaltrials.gov (NCT04411056) on May 27, 2020

Comparing the corneal curvatures obtained from three different keratometers-IOL Master, Bausch & Lomb Manual keratometer and TOPCON KR 8800 autokeratometer

2020 ◽  
Vol 1 (1) ◽  
pp. 13-16
Author(s):  
Arpitha Pereira ◽  
Keyword(s):  
Surgical Planning ◽  
Outcome Measure ◽  
Corneal Curvature ◽  
Limits Of Agreement ◽  
Altman Plot ◽  
Main Outcome Measure ◽  
Corneal Power ◽  
Significant Difference ◽  
The Mean ◽  
Paired T Test

AIM: To compare the corneal curvature and to investigate the agreement between three different keratometers. METHODS: In this prospective study, keratometry was performed using an IOL Master, a Bausch & Lomb manual keratometer and TOPCON KR-8800 autokeratometer on 252 eyes of patients recruited from camps for cataract surgery. The average keratometry values were recorded and compared. The agreements between the instruments were analyzed using the Bland Altman statistical method. The main outcome measure was average keratometry values.RESULTS: The mean corneal power was 44.62±1.52 D with the IOL Master, 44.60±1.52 D with the manual keratometer, and 44.46±1.53 D with the autokeratometer. The paired t test demonstrated a statistically significant difference in the mean corneal power between the IOL Master and manual keratometer (P=0.001), IOL Master and autokeratometer (P<0.0001), autokeratometer and manual keratometer (P<0.0001). The 95% limits of agreement (LoA) of the IOL Master and manual keratometer were -0.22 to 0.26; IOL Master and autokeratometer were -0.24 to 0.55; autokeratometer and manual keratometer were -0.30 to 0.57 as shown in the Bland-Altman plot. CONCLUSION: Keratometry data obtained with different instruments may not be interchangeable, a fact that has important implications for cataract surgeons with respect to both surgical planning and outcomes auditing.

scholarly journals Reliability, comparative validity and stability of dietary patterns derived from an FFQ in the Tehran Lipid and Glucose Study

2012 ◽  
Vol 108 (6) ◽  
pp. 1109-1117 ◽  
Author(s):  
Golaleh Asghari ◽  
Arezoo Rezazadeh ◽  
Firoozeh Hosseini-Esfahani ◽  
Yadollah Mehrabi ◽  
Parvin Mirmiran ◽  
...  
Keyword(s):  
Factor Analysis ◽  
Dietary Patterns ◽  
Reliability And Validity ◽  
Factor Scores ◽  
Limits Of Agreement ◽  
The Third ◽  
The Mean ◽  
The Difference ◽  
The Stability ◽  
Traditional Pattern

The aim of the present study was to assess the reliability, comparative validity and stability of dietary patterns defined by factor analysis for participants of the Tehran Lipid and Glucose Study. A total of 132 subjects, aged ≥ 20 years, completed a 168-item FFQ (FFQ1, FFQ2) twice, with a 14-month interval. Over this duration, twelve dietary recalls (DR) were collected each month. To assess the stability of the FFQ, participants completed the third FFQ (FFQ3) after 8 years. Following these, two dietary patterns – the ‘Iranian Traditional’ and the ‘Western’ – were derived from FFQ1 and FFQ2 and the mean of DR (mDR); and three dietary patterns were identified from FFQ3: the ‘Iranian Traditional’, the ‘Western’ and the ‘Combined’. The reliability correlations between factor scores of the two FFQ were 0·72 for the Iranian Traditional and 0·80 for the Western pattern; corrected month-to-month variations of DR correlations between the FFQ2 and mDR were 0·48 for the first and 0·75 for the second pattern. The 95 % limits of agreement for the difference between factor scores obtained from FFQ2 and mDR lay between − 1·58 and +1·58 for the Iranian Traditional and between − 1·33 and +1·33 for the Western pattern. The intra-class correlations between FFQ2 and FFQ3 were − 0·09 (P = 0·653) and 0·49 (P <0·001) for the ‘Iranian Traditional’ and the ‘Western’, respectively. These data indicate reasonable reliability and validity of the dietary patterns defined by factor analysis. Although the Western pattern was found to be fairly stable, the Iranian Traditional pattern was mostly unstable over the 8 years of the study period.

scholarly journals International normalized ratio (INR) testing in Europe: between-laboratory comparability of test results obtained by Quick and Owren reagents

2018 ◽  
Vol 56 (10) ◽  
pp. 1698-1703 ◽  
Author(s):  
Piet Meijer ◽  
Karin Kynde ◽  
Antonius M.H.P. van den Besselaar ◽  
Marjan Van Blerk ◽  
Timothy A.L. Woods
Keyword(s):  
Plasma Sample ◽  
International Normalized Ratio ◽  
Test Results ◽  
Local Calibration ◽  
The Mean ◽  
The Difference ◽  
Clinically Significant ◽  
Single Plasma ◽  
Better Than

Abstract Background: This study was designed to obtain an overview of the analytical quality of the prothrombin time, reported as international normalized ratio (INR) and to assess the variation of INR results between European laboratories, the difference between Quick-type and Owren-type methods and the effect of using local INR calibration or not. In addition, we assessed the variation in INR results obtained for a single donation in comparison with a pool of several plasmas. Methods: A set of four different lyophilized plasma samples were distributed via national EQA organizations to participating laboratories for INR measurement. Results: Between-laboratory variation was lower in the Owren group than in the Quick group (on average: 6.7% vs. 8.1%, respectively). Differences in the mean INR value between the Owren and Quick group were relatively small (<0.20 INR). Between-laboratory variation was lower after local INR calibration (CV: 6.7% vs. 8.6%). For laboratories performing local calibration, the between-laboratory variation was quite similar for the Owren and Quick group (on average: 6.5% and 6.7%, respectively). Clinically significant differences in INR results (difference in INR>0.5) were observed between different reagents. No systematic significant differences in the between-laboratory variation for a single-plasma sample and a pooled plasma sample were observed. Conclusions: The comparability for laboratories using local calibration of their thromboplastin reagent is better than for laboratories not performing local calibration. Implementing local calibration is strongly recommended for the measurement of INR.

scholarly journals Agreement analysis between critical power and intensity corresponding to 50% in cycling exercise

2016 ◽  
Vol 18 (2) ◽  
pp. 197 ◽  
Author(s):  
Kristopher Mendes de Souza ◽  
Ricardo Dantas de Lucas ◽  
Paulo Cesar do Nascimento Salvador ◽  
Lucas Crescenti Abdalla Saad Helal ◽  
Luiz Guilherme Antonacci Guglielmo ◽  
...  
Keyword(s):  
Oxygen Uptake ◽  
Lactate Threshold ◽  
Critical Power ◽  
Limits Of Agreement ◽  
Cycling Exercise ◽  
Significant Difference ◽  
The Mean ◽  
The Difference ◽  
Male Subjects ◽  
Level Of Agreement

DOI: http://dx.doi.org/10.5007/1980-0037.2016v18n2p197 The purpose of this study was to determine the level of agreement between critical power (CP) and intensity corresponding to 50% of the difference (50% Δ) between oxygen uptake (VO2) at lactate threshold (LT) and maximal oxygen uptake (VO2max) in untrained subjects during cycling exercise. Fifteen healthy male subjects (age: 26.0 ± 3.5 years; body weight: 76.6 ± 10.4 kg; height: 178.2 ± 7.6 cm) volunteered to participate in the study. Each subject performed a series of tests to determine LT, VO2LT, CP, VO2CP, 50% Δ, VO250% Δ, and VO2max. The values of LT, VO2LT, CP, VO2CP, 50% Δ, VO250% Δ and VO2max were 109 ± 15 W, 1.84 ± 0.23 L.min-1, 207 ± 17 W, 2.78 ± 0.27 L.min-1, 206 ± 19 W, 2.77 ± 0.29 L.min-1, and 3.71 ± 0.49 L.min-1, respectively. No significant difference was found between CP and 50% Δ (t = 0.16; p = 0.87) or between VO2CP and VO250% Δ (t = 0.12; p = 0.90). However, the bias ± 95% limits of agreement for comparison between CP and 50% Δ and between VO2CP and VO250% Δ were 1 ± 27 W (0.3 ± 14.1%) and 0.01 ± 0.24 L.min-1 (0.2 ± 8.9%), respectively. In summary, the mean CP and 50% Δ values were not significantly different. However, considering the limits of agreement between the two intensities, CP estimated based on 50% Δ might result in a remarkable error when the absolute variability of individual differences is taken into account

scholarly journals The fulcrum axis: an accurate measure of glenoid version on radiographs and computed tomography

2017 ◽  
Vol 11 (2) ◽  
pp. 79-86
Author(s):  
Jennifer Mutch ◽  
Martin Sidler ◽  
Claudia Sidler-Maier ◽  
Terry Axelrod ◽  
Diane Nam
Keyword(s):  
Computed Tomography ◽  
Shoulder Arthroplasty ◽  
Gold Standard ◽  
Total Shoulder Arthroplasty ◽  
Three Dimensional ◽  
Absolute Difference ◽  
Single Institution ◽  
Glenoid Version ◽  
Rater Reliability ◽  
The Mean

Background Proper glenoid position in total shoulder arthroplasty (TSA) is important. However, traditional glenoid version (GV) measurements overestimate retroversion on radiographs (XR) and computed tomography (CT). The fulcrum axis (FA) uses palpable surface landmarks and may be useful as an intra-operative guide. Also, the FA has not yet been validated on XR or CT in an arthritic population. Methods Four observers measured FA and GV on the XR, CT and three-dimensional CT (3DCT) of 40 patients who underwent TSA at a single institution from 2009 to 2015. Reliability and accuracy of FA and GV were calculated for XR and CT, using 3DCT as the gold standard. Results The mean FA and GV were 7.768° and 18.910° on XR; 6.23° and 12.920° on CT; and 8.100° and 7.740° on 3DCT, respectively. FA and GV were significantly different for XR and CT ( p < 0.001) but not for 3DCT ( p = 0.725). The inter-rater reliability, intra-rater reliability and accuracy of FA were not significantly different from GV and were 0.929 to 0.948, 0.779 to 0.974 and 0.674 to 0.705, respectively. However, the absolute difference of FA was closer to the gold standard (3DCT) than GV for XR (0.330° versus 11.172°) and CT (1.871° versus 5.178°) ( p < 0.001). Conclusions FA showed comparable reliability and accuracy to GV. However, FA more accurately reflected the gold standard.

Effect of intradermal anaesthesia on success rate and pain of intravenous cannulation: a randomized non-blind crossover study

2011 ◽  
Vol 56 (4) ◽  
pp. 210-213 ◽  
Author(s):  
F Hendry ◽  
M R Checketts ◽  
G A Mcleod
Keyword(s):  
Success Rate ◽  
Intervention Group ◽  
Pain Scale ◽  
Visual Analogue Pain Scale ◽  
Visual Analogue Pain ◽  
Pain Scores ◽  
The Mean ◽  
The Difference ◽  
Clinically Significant ◽  
Log Linear

Intravenous cannulation is a commonly performed procedure. This study aimed to determine whether the success rate and pain of intravenous cannulation is affected by prior injection of intradermal lidocaine. Intravenous cannulation was performed twice in 45 healthy volunteers. Intradermal lidocaine was administered prior to one of these cannulations. The outcome measures were success or failure of cannulation, and pain of cannulation, measured with a 100 mm visual analogue pain scale. The success rate of intravenous cannulation with and without prior intradermal lidocaine was 54% and 76%, respectively. The difference was 22.0% (95% CI 1.5-27.8%; P = 0.03). Log-linear analysis for three-way interaction between the variables (outcome, vascular condition and use of lidocaine) showed a significant influence of vascular condition on outcome ( G 2 24.6, P < 0.001). The mean (SD) pain scores in the control and intervention group were 34.8 (21.0) and 13.6 (13.2) mm, respectively. The difference between the mean pain scores was 21.2 mm (95% CI 15.1-27.3 mm). In conclusion, the success rate of intravenous cannulation may be reduced with the use of intradermal lidocaine, but success rate is primarily dependent on vascular condition. Intradermal lidocaine achieves a clinically significant reduction in the pain of intravenous cannulation.

scholarly journals Accuracy of Humeral Implant Positioning Using a Canal-Sparing Total Shoulder Arthroplasty System

2019 ◽  
Vol 3 ◽  
pp. 247154921984483
Author(s):  
Eric S Baranek ◽  
David P Trofa ◽  
William N Levine ◽  
Steven S Goldberg
Keyword(s):  
Shoulder Arthroplasty ◽  
Humeral Head ◽  
Glenohumeral Joint ◽  
Total Shoulder Arthroplasty ◽  
Case Series ◽  
Humeral Head Prosthesis ◽  
The Difference ◽  
Clinically Significant ◽  
Shoulder Arthroplasties ◽  
Improved Accuracy

Background Accurate restoration of anatomy is critical in reestablishing proper glenohumeral joint function in total shoulder arthroplasty (TSA). However, even experienced surgeons inconsistently achieve anatomic restoration. This study evaluates whether a new canal-sparing arthroplasty system, designed using the principles of calibrated bone resection and incorporating a nonspherical humeral head prosthesis, can assist in more accurate and reliable reproduction of proximal humeral anatomy compared to a stemmed arthroplasty system. Methods The difference between the anatomic center of rotation (COR) of the humeral head and the postoperative prosthetic COR (defined as ΔCOR) was measured in a consecutive case series of 110 shoulder arthroplasties performed by a single surgeon. The first 55 cases used a stemmed arthroplasty system and the subsequent 55 cases used a new canal-sparing implant system that uses a multiplanar osteotomy (MPO) during humeral head preparation. Cases with ΔCOR ≥3.0 mm were deemed clinically significant outliers. Results The average ΔCOR in the MPO group was 1.7 ± 1.2 mm versus 2.8 ± 1.5 mm in the stemmed group ( P = .00005). The incidence of outliers was lower (14.5% vs 40.0%, P = .005), and there were more cases with a ΔCOR ≤1.0 mm (32.7% vs 3.6%, P = .0001) in the MPO group compared to the stemmed group. Conclusion The MPO TSA system provided improved accuracy and precision in restoring proximal humeral anatomy compared to stemmed arthroplasty systems, even in its initial use. This alternative method of humeral replacement may increase consistency in restoring proper anatomy and kinematics in TSA.

scholarly journals The equivalence of hydration status measured by the Fresenius BCM and the Cella Bioimpedance Spectroscopy devices on hemodialysis patients

2021 ◽  
Author(s):  
Jim Matthie ◽  
Borut Baricevic ◽  
Vlasta Malnaric Marentic ◽  
Boris Krajacic
Keyword(s):  
Statistical Power ◽  
Fluid Management ◽  
Hydration Status ◽  
P Value ◽  
Bioimpedance Spectroscopy ◽  
Promising Technique ◽  
Limits Of Agreement ◽  
Body Composition Monitor ◽  
The Mean ◽  
The Difference

AbstractBackgroundFluid management is a serious challenge for patients undergoing hemodialysis therapy (HD). Bioimpedance spectroscopy (BIS) is a promising technique to help with clinical hydration (HYD) assessment. The Fresenius Medical Care (FMC) Body Composition Monitor (BCM) is the standard but is large and expensive. Cella Medical has introduced a small wireless BIS device. This study compared the HYD status predicted by the two devices.MethodsFollowing the FMC BCM device manual guidelines, measurements of BIS were made wrist-ankle using typical ECG electrodes on the non-fistula side of HD patients pre dialysis while in their normal supine position. As usual, patients were measured before their normal time of therapy with the BCM. The Cella measurements were then performed within two minutes.ResultsForty-two HD patients (M=64%, age=64±30 yrs.), were measured. One patient data was removed. The mean BCM HYD status was 1.86 l, SD 1.46 l, and SEM 0.22 l. Cella was 1.806 l, SD 1.36 l, and the SEM 0.21 l. The 95% difference confidence interval (CI) was -0.66 to 0.55 l. The Pearson’s correlation (r) was r^2 = 0.85 (p<0.00001). There was no proportional bias: the offset was -0.056 l, and K=1.010. The limits of agreement (LOA) analysis showed a mean difference of 0.56 l, and limits d ±2SD = (−1.192 l, 1.081 l), indicating 95% of the difference will lie within these limits. To evaluate equivalence, we performed two one-sided t-tests (TOST). When the bounds were reduced to the limit =0.47 l and -0.59 l, we obtained a 0.046 p-value (alpha =0.05), at 80% statistical power. For 26% of the subjects, the difference was <0.1 l, for 43% <0.25 l, for 71% <0.5 l, for 83% <0.75 l, for 90% <1.0 l, and for 9.5% (4 patients) more than 1 l. Only two cases (4.8%) were just over the ±2SD limit.ConclusionThis study suggests the BCM and Cella devices can be used interchangeably.

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