scholarly journals Knee surgery and its evidence base

2016 ◽  
Vol 98 (03) ◽  
pp. 170-176 ◽  
Author(s):  
A Sharma ◽  
K Hasan ◽  
A Carter ◽  
R Zaidi ◽  
S Cro ◽  
...  
Keyword(s):  
Statistical Significance ◽  
Evidence Base ◽  
Knee Surgery ◽  
Level Of Evidence ◽  
Significant Drop ◽  
Levels Of Evidence ◽  
Published Evidence ◽  
Significant Downward Trend ◽  
Level I ◽  
High Level

Introduction Evidence driven orthopaedics is gaining prominence. It enables better management decisions and therefore better patient care. The aim of our study was to review a selection of the leading publications pertaining to knee surgery to assess changes in levels of evidence over a decade. Methods Articles from the years 2000 and 2010 in The Knee, the Journal of Arthroplasty, Knee Surgery, Sports Traumatology, Arthroscopy, the Journal of Bone and Joint Surgery (American Volume) and the Bone and Joint Journal were analysed and ranked according to guidelines from the Centre for Evidence-Based Medicine. The intervening years (2003, 2005 and 2007) were also analysed to further define the trend. Results The percentage of high level evidence (level I and II) studies increased albeit without reaching statistical significance. Following a significant downward trend, the latter part of the decade saw a major rise in levels of published evidence. The most frequent type of study was therapeutic. Conclusions Although the rise in levels of evidence across the decade was not statistically significant, there was a significant drop and then rise in these levels in the interim. It is therefore important that a further study is performed to assess longer-term trends. Recent developments have made clear that high quality evidence will be having an ever increasing influence on future orthopaedic practice. We suggest that journals implement compulsory declaration of a published study’s level of evidence and that authors consider their study designs carefully to enhance the quality of available evidence.

Comparing Midterm Outcomes of High-Level Athletes Versus Nonathletes Undergoing Primary Hip Arthroscopy: A Propensity-Matched Comparison With Minimum 5-Year Follow-up

2021 ◽  
pp. 036354652110417
Author(s):  
Andrew E. Jimenez ◽  
Peter F. Monahan ◽  
David R. Maldonado ◽  
Benjamin R. Saks ◽  
Hari K. Ankem ◽  
...  
Keyword(s):  
Hip Arthroscopy ◽  
Statistical Significance ◽  
Arthroscopic Surgery ◽  
Harris Hip Score ◽  
Control Group ◽  
Level Of Evidence ◽  
Femoroacetabular Impingement Syndrome ◽  
Patient Reported ◽  
High Level

Background: High-level athletes (HLAs) have been shown to have better short-term outcomes than nonathletes (NAs) after hip arthroscopy. Purpose: (1) To report midterm outcomes of HLAs after primary hip arthroscopy and (2) to compare their results with a propensity-matched cohort of NA patients. Study Design: Cohort study; Level of evidence, 3. Methods: Data were prospectively collected and retrospectively reviewed between February 2008 and November 2015 for HLAs (professional, college, or high school) who underwent primary hip arthroscopy in the setting of femoroacetabular impingement syndrome (FAIS). HLAs were included if they had preoperative, minimum 2-year, and minimum 5-year follow-up data for the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), and Hip Outcome Score Sports-Specific Subscale (HOS-SSS). Radiographic and intraoperative findings, surgical procedures, patient-reported outcomes (PROs), patient acceptable symptomatic state (PASS), minimal clinically important difference (MCID), and return to sport were reported. The HLA study group was propensity-matched to a control group of NA patients for comparison. Results: A total 65 HLA patients (67 hips) were included in the final analysis with mean follow-up time of 74.6 ± 16.7 months. HLAs showed significant improvement in all PROs recorded, achieved high rates of MCID and PASS for mHHS (74.6% and 79.4%, respectively) and HOS-SSS (67.7% and 66.1%, respectively), and returned to sport at high rates (80.4%). When compared with the propensity-matched NA control group, HLAs reported higher baseline but comparable postoperative scores for the mHHS and NAHS. HLA patients achieved MCID and PASS for mHHS at similar rates as NA patients, but the HLA patients achieved PASS for HOS-SSS at higher rates that trended toward statistical significance (66.1% vs 48.4%; P = .07). NA patients underwent revision arthroscopic surgery at similar rates as HLA patients (14.9% vs 9.0%, respectively; P = .424). Conclusion: Primary hip arthroscopy results in favorable midterm outcomes in HLAs. When compared with a propensity-matched NA control group, HLAs demonstrated a tendency toward higher rates of achieving PASS for HOS-SSS but similar arthroscopic revision rates at minimum 5-year follow-up.

scholarly journals Safety of Outpatient Anterior Cervical Discectomy and Fusion: A Systematic Review and Meta-Analysis

Neurosurgery ◽  
2019 ◽  
Vol 86 (1) ◽  
pp. 30-45 ◽  
Author(s):  
Ketan Yerneni ◽  
John F Burke ◽  
Pranathi Chunduru ◽  
Annette M Molinaro ◽  
K Daniel Riew ◽  
...  
Keyword(s):  
Safety Profile ◽  
Meta Analysis ◽  
Anterior Cervical Discectomy ◽  
Complication Rates ◽  
Outpatient Basis ◽  
Level Of Evidence ◽  
Cervical Discectomy ◽  
Significant Difference ◽  
Level I ◽  
High Level

ABSTRACT BACKGROUND Anterior cervical discectomy and fusion (ACDF) is being increasingly offered on an outpatient basis. However, the safety profile of outpatient ACDF remains poorly defined. OBJECTIVE To review the medical literature on the safety of outpatient ACDF. METHODS We systematically reviewed the literature for articles published before April 1, 2018, describing outpatient ACDF and associated complications, including incidence of reoperation, stroke, thrombolytic events, dysphagia, hematoma, and mortality. A random-effects analysis was performed comparing complications between the inpatient and outpatient groups. RESULTS We identified 21 articles that satisfied the selection criteria, of which 15 were comparative studies. Most of the existing studies were retrospective, with a lack of level I or II studies on this topic. We found no statistically significant difference between inpatient and outpatient ACDF in overall complications, incidence of stroke, thrombolytic events, dysphagia, and hematoma development. However, patients undergoing outpatient ACDF had lower reported reoperation rates (P < .001), mortality (P < .001), and hospitalization duration (P < .001). CONCLUSION Our meta-analysis indicates that there is a lack of high level of evidence studies regarding the safety of outpatient ACDF. However, the existing literature suggests that outpatient ACDF can be safe, with low complication rates comparable to inpatient ACDF in well-selected patients. Patients with advanced age and comorbidities such as obesity and significant myelopathy are likely not suitable for outpatient ACDF. Spine surgeons must carefully evaluate each patient to decide whether outpatient ACDF is a safe option. Higher quality, large prospective randomized control trials are needed to accurately demonstrate the safety profile of outpatient ACDF.

scholarly journals Development of AOSpine BOnE (Bone Osteobiologics and Evidence) Classification

2019 ◽  
Vol 10 (7) ◽  
pp. 871-874 ◽  
Author(s):  
Jeffrey C. Wang ◽  
S. Tim Yoon ◽  
Darrel S. Brodke ◽  
Jong-Beom Park ◽  
Patrick Hsieh ◽  
...  
Keyword(s):  
Small Sample Size ◽  
Small Sample ◽  
In Vitro Studies ◽  
Level Of Evidence ◽  
Knowledge Forum ◽  
Levels Of Evidence ◽  
Published Evidence ◽  
Patient Reported

Study Design: Classification development. Objectives: The aim of our study was to develop a 3-tier classification for the levels of evidence for osteobiologics and provide a description of the principles by which osteobiologics can be evaluated. BOnE (Bone Osteobiologics and Evidence) classification evaluates each osteobiologic based on the available evidence, and if the published evidence is based on clinical, in vivo or in vitro studies. Methods: The process of establishing the BOnE classification included 5 face-to-face meetings and 2 web calls among members of the AOSpine Knowledge Forum Degenerative. Results: The 3 levels of evidence were determined based on the type of data on osteobiologics: level A for human studies, level B for animal studies, and level C for in vitro studies, with level A being the highest level of evidence. Each level was organized into 4 subgroups (eg, A1, A2, A3, and A4). Conclusions: The use and the variety of osteobiologics for spine fusion has dramatically increased over the past few decades; however, literature on their effectiveness is inconclusive. Several prior systematic reviews developed by AOSpine Knowledge Forum Degenerative reported low level of evidence primarily due to the high risk of bias, small sample size, lack of control groups, and limited patient-reported outcomes. BOnE classification will provide a universal platform for research studies and journal publications to classify a new or an existing product and will allow for creating decision-making algorithms for surgical planning.

The experience of conducting a Cochrane systematic review of the impact of clinical pathways on professional practice, patient outcomes, length of stay and hospital costs

2009 ◽  
Vol 13 (2) ◽  
pp. 62-66 ◽  
Author(s):  
Thomas Rotter ◽  
Leigh Kinsman ◽  
Erica James ◽  
Andreas Machotta ◽  
Holger Gothe ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Pathways ◽  
Hospital Costs ◽  
Evidence Base ◽  
Care Group ◽  
Level Of Evidence ◽  
Organisation Of Care ◽  
High Level ◽  
Meta Analyses ◽  
The Impact

Despite the high prevalence of clinical pathways (CPWs), the results from published studies are inconsistent and contradictory. The plethora of study designs, settings and lack of an agreed definition of a CPW make the relevance of individual studies difficult to apply to clinical settings. It was timely to catalogue and analyse the existing evidence base for CPWs via a rigorous systematic review. Systematic reviews and meta-analyses provide a high level of evidence for the effectiveness of interventions and are commonly employed reviewing strategies for addressing scientific questions in health-related research. This method is especially useful when research results are known to be inconsistent. Instead of conducting another primary evaluation, a detailed review is needed that reflects a summation of available research. This paper reports and discusses methodological and technical issues of a systematic review of the effectiveness of CPWs in hospitals, based on our experience with the Cochrane Effective Practice and Organisation of Care Group.

Is It Possible to Consider Management of Chronic Diseases as Method of Population Screening in Ukraine?

2016 ◽  
pp. 41-44
Author(s):  
Pavlo Kolesnik ◽  
Ivanna Shushman ◽  
Yevheniia Sinevich
Keyword(s):  
United States ◽  
Health Care ◽  
Comparative Analysis ◽  
Chronic Diseases ◽  
Developed Countries ◽  
The United States ◽  
Evidence Base ◽  
Population Screening ◽  
Level Of Evidence ◽  
High Level

The article presents a comparative analysis of the effectiveness of different methods used during the management of diseases based on the Order of the Ministry of Health Care of Ukraine № 728 from 27.08.2010. and methods used in highly developed countries of Europe and the United States as a mandatory screening with high level of evidence base.

scholarly journals Evaluación de la superficie del esmalte luego de la descementación de brackets metálicos. Revisión sistemática / Enamel Surface Assessment after Metallic Bracket Debonding. A Systematic Review

2018 ◽  
Vol 36 (77) ◽  
Author(s):  
Nicolás Arboleda Ariza ◽  
Isaac Wasserman Milhem ◽  
Diana Katherina Reina Velosa ◽  
Ingrid Quintero Quinche
Keyword(s):  
Systematic Review ◽  
High Speed ◽  
Control Group ◽  
Level Of Evidence ◽  
Double Blind ◽  
Adhesive Resin ◽  
Published Evidence ◽  
Revisión Sistemática ◽  
High Level ◽  
Surface Assessment

RESUMEN. Antecedentes: A través del tiempo se han propuesto diferentes técnicas para realizar la remoción del adhesivo y resina remanentes luego de retirar los brackets, pero no existe un consenso entre los diferentes autores. Objetivo: el propósito de esta revisión sistemática fue identificar cuál es la técnica más adecuada para evitar injuria al esmalte durante la remoción de la resina remanente después de retirados los brackets. Métodos: Esta revisión sistemática se basó en los lineamientos de PRISMA, Para recolectar la evidencia publicada se realizó una búsqueda electrónica en diferentes bases de datos. Resultados: Se encontraron 8 artículos con una evidencia media (> de 9) los cuales fueron considerados en esta revisión sistemática. Al parecer la remoción de resina y adhesivo remanentes con ultrasonido, fresa de carburo de tungsteno de alta velocidad y piedras blancas generan la mayor pérdida de esmalte, mientras que 6 artículos proponen la fresa de tungsteno de baja velocidad como la mejor técnica. Conclusiones: Se requieren estudios aleatorizados, con grupo control, doble-ciego y una técnica de análisis del esmalte estandarizada para poder generar un nivel de evidencia alto y dar recomendaciones más acertadas para el clínico.ABSTRACT. Background: Over time different techniques have been proposed for the removal of the remaining adhesive and resin after the removal of brackets, but there is no consensus among authors. Objective: Evaluate the most appropriate technique to prevent injury to the enamel during the removal of the remaining resin after the brackets are removed. Methods: This systematic review is based on the guidelines of PRISMA, to collect the published evidence there was a various electronic databases search. Results: There were only 8 items with medium evidence (> 9) which were considered in this systematic review. Apparently removing remaining adhesive resin with ultrasound, tungsten carbide cutter high speed and white stones generate the greatest loss of enamel, while 6 articles propose the tungsten bur at low speed as the best technique. Conclusions: Randomized studies with control group, double-blind and a standardized technique of enamel analysis are required to generate a high level of evidence and give more accurate recommendations for clinicians.

scholarly journals Trends in Publication and Levels of Evidence in Foot and Ankle International From 2000-2015

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0023
Author(s):  
Matthew Griffith ◽  
Edward Han ◽  
Joshua Hattaway ◽  
Jeannie Huh
Keyword(s):  
Scientific Quality ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
Levels Of Evidence ◽  
Publication Rates ◽  
Orthopaedic Literature ◽  
Chi Squared ◽  
Commercial Sources ◽  
Level I ◽  
Study Type

Category: Other Introduction/Purpose: As the movement towards evidence-based medicine grows and publication rates rise each year, critical analysis of the orthopaedic literature has become increasingly important. To aid readers in assessing the scientific quality of published research, Foot and Ankle International (FAI) began assigning levels of evidence to all clinical articles in 2008. The purpose of this study was to analyze trends in the characteristics and levels of evidence of articles published in FAI between 2000 and 2015. Methods: All articles published in FAI from 2000, 2005, 2010, and 2015 were reviewed and categorized into article type (clinical, basic science, review, or technical tip). Each clinical article was assigned a level of evidence (I-V) and study type (prognostic, therapeutic, economic, or diagnostic). Descriptive information was gathered pertaining to: country of origin, authorship, and funding. Statistical analysis was performed using chi-squared tests to detect any trends in levels of evidence and publication characteristics. Results: 647 articles were reviewed from 2000 to 2015. There was a statistically significant increase in the publication of clinical articles (70% to 83%; p=0.013). The publication of levels I and II evidence significantly increased (2.44% to 13.53%; p=0.002). Although levels III-V evidence also increased (65% to 70.6%, p=1.014), this was not statistically significant. Publications originated from 39 countries, with a significant increase in the proportion of international papers (32.8% to 48%%; p=0.007). The proportion of articles authored by Podiatrists during the study period significantly decreased (3.73% to 1.74%, p=0.035). Finally, there was an increase in funding disclosures during the study period; funding from grants or professional groups rose from 2.44% to 15.9% (p<0.001) and reported funding from commercial sources rose from 0% to 9.41% (p=0.002). Conclusion: The proportion of level I and II studies published in FAI significantly increased from 2000 to 2015. The publication of clinical research rose, with a majority being therapeutic studies. There was a significant increase in articles published by international authors and a significant decrease in articles published by DPMs. During the same time period, there was a rise in the proportion of articles reporting the use of outside funding, both professional and commercial.

scholarly journals Publication characteristics of studies published in the The Spine Journal from 2005 to 2015

2019 ◽  
Author(s):  
Joseph Park ◽  
Joseph A. Gil ◽  
Justin Kleiner ◽  
Adam E.M. Eltorai ◽  
Alan H. Daniels
Keyword(s):  
Clinical Decision Making ◽  
Fold Increase ◽  
Clinical Decision ◽  
Funding Source ◽  
Chi Square ◽  
Level Of Evidence ◽  
Level I ◽  
High Level ◽  
Study Type ◽  
Number Of Citations

BACKGROUND CONTEXT: There is a growing demand for evidence-based- practices and informed clinical decision making supported by reliable, high-quality research.PURPOSE: To analyze trends in the level of evidence of publications and to evaluate the publication characteristics that influence the quality of research in The Spine Journal (TSJ)STUDY DESIGN: Comprehensive publication assessment.SAMPLE: All studies published in TSJ from the years 2005, 2007, 2009, 2011, 2013, and 2015 were reviewed and analyzed.OUTCOME MEASURES: Level of evidence, study type, funding source, author country, author department, and number of citations.METHODS:  Multivariable logistic regression, and multivariable linear regression analyses, and chi square tests were used to analyze the trends of published studies level of evidence, study type, the specialties of authors, author countries, number of citations, and funding sources.RESULTS: A total of 1,456 articles were evaluated. There was a decrease in the percentage of high level evidence (level 1 and 2) studies from 73.6% in 2005 to 49.8% in 2015 (p=0.0045). There was a significant increase in the percentage studies with reporting funding support (p<0.0001). Funded studies were more likely to have a higher level of evidence (p<0.0001). The percentage of studies from international authors increased from 17.8% in 2005 to 69.1% in 2015 (p<0.0001). The percentage of studies with orthopedic authors decreased from 67% in 2005 to 44.9% in 2015 with a corresponding increase in the percentage of studies with neurosurgeon authors from 14.4% in 2005 to 23.2% by 2015, as well as an increase in the percentage of studies with a collaboration of authors from both specialties from 5.1% in 2005 to 8.7% in 2015 (p = 0.0007). Orthopedic and neurosurgery collaboration in authorship did not affect the level of evidence of the studies nor the number of citations of the studies (p=0.7583). Earlier studies had a higher SCOPUS citation number but were not affected by the level of evidence (p=0.2515) nor the department of the author(s) (p=0.9107).CONCLUSIONS: The publication characteristics of articles in TSJ have evolved between 2005 and 2015 with a 3.9-fold increase in International authorship and a 32% decrease in the proportion of Level I and Level II studies. Inter-departmental collaboration, funding source, and country of origin may affect level of evidence and number of citations. Continued efforts to increase level of evidence should be considered.

scholarly journals Quality of information of websites dedicated to obesity: a systematic search to promote high level of information for Internet users and professionals

2021 ◽  
Author(s):  
Alessandra Perra ◽  
Antonio Preti ◽  
Valerio De Lorenzo ◽  
Antonio Egidio Nardi ◽  
Mauro G. Carta
Keyword(s):  
Poor Quality ◽  
Quality Of Information ◽  
Level Of Evidence ◽  
Flesch Reading Ease ◽  
Internet Users ◽  
Treatment Support ◽  
Technological Quality ◽  
Level I ◽  
High Level

Abstract Background The Internet is increasingly used as a source of information. This study investigates with a multidimensional methodology the quality of information of websites dedicated to obesity treatment and weight-loss interventions. We compared websites in English, a language that it is used for the international scientific divulgation, and in Italian, a popular local language. Methods Level of Evidence: Level I, systematic review search on four largely used search engines. Duplicated and unrelated websites were excluded. We checked: popularity with PageRank; technological quality with Nibbler; readability with the Flesch Reading Ease test or the Gulpease readability index; quality of information with the DISCERN scale, the JAMA benchmark criteria, and the adherence to the Health on the Net Code. Results 63 Italian websites and 41 English websites were evaluated. English websites invested more in the technological quality especially for the marketing, experience of the user, and mobile accessibility. Both the Italian and English websites were of poor quality and readability. Conclusions These results can inform guidelines for the improvement of health information and help Internet users to achieve a higher level of information. Users must find benefits of treatment, support to the shared decision-making, the sources used, the medical editor's supervision, and the risk of postponing the treatment.

scholarly journals Has the Level of Evidence in Orthopaedic Trauma and Nontrauma Publications Improved? A Publication Review of 3 Major Orthopaedic Journals

2020 ◽  
Author(s):  
Kitchai Luksameearunothai ◽  
Yash Paul Chaudhry ◽  
Sorawut Thamyongkit ◽  
Xiaofeng Jia ◽  
Erik A. Hasenboehler
Keyword(s):  
Biomedical Research ◽  
Trauma Studies ◽  
Orthopaedic Trauma ◽  
Level Of Evidence ◽  
Related Research ◽  
Research Level ◽  
Orthopaedic Literature ◽  
Level I ◽  
High Level

Abstract Background In biomedical research, level of evidence (LOE) indicates the quality of a study. Recent studies evaluating orthopaedic trauma literature between 1998-2013 have indicated that LOE in this field has improved. The objective of this study was to determine the validity of one such study by 1) comparing our results and how they relate to more recent years of publications; and 2) assessing how our findings may be used to estimate future changes. Methods A total of 3,449 articles published from 2013 to 2018 in The Journal of Orthopaedic Trauma (JOT); Journal of Bone and Joint Surgery, American Volume (JBJS-Am); and Clinical Orthopaedics and Related Research (CORR) were evaluated for their LOE. Articles published in JBJS-Am or CORR were classified as trauma or nontrauma studies; articles published in JOT were considered trauma studies. Articles were assigned a LOE using guidance published by JBJS-Am in 2015. Results The percentage of total high-level (level I or II) trauma and nontrauma articles published in JOT, JBJS-Am, and CORR decreased from 2013 to 2018 (trauma 23.1% to 19.2%, p = 0.190; nontrauma 28.8% to 24.9%, p = 0.037). JBJS-Am published the highest percentage of level-I trauma studies, and CORR published the lowest percentage of level-IV studies. JBJS-Am and CORR published higher percentages of level-I trauma studies and lower percentages of level-IV nontrauma studies than all trauma studies. Conclusions Based on our results we cannot validate the findings of previous studies as we found the overall LOE of both trauma and nontrauma orthopaedic literature has decreased in recent years. JBJS-Am published a greater percentage of high-level studies than did JOT and CORR. Although the number and percentage of high-level studies published in JOT increased during the study period, it still lagged behind JBJS-Am and CORR.

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