Postoperative controls of ventilation tubes in children - by general practitioner or otolaryngologist? Study protocol for a multicenter, randomized, controlled trial (The ConVenTu study)

Abstract Background Insertion of ventilation tubes (VTs) in the tympanic membrane is one of the most common ambulatory surgeries performed on children. Postoperative care may continue for two or more years and is today mostly done by otolaryngologists. Controls by general practitioners (GPs) may represent a sufficient level of health care regarding clinical outcome, but there exist no evidence-based guidelines concerning the level of expertise for this task. Aim To evaluate whether postoperative care after surgery with VTs performed by GPs represent a sufficient alternative to otolaryngologists. Methods/design Randomized controlled trial including patients from seven hospitals in all four Regional Health Authorities in Norway. A total of 400 children aged 3-10 years will be randomized to postoperative care by either otolaryngologist or their regular GP after surgery with VTs in the tympanic membrane. Two years after surgery we will compare hearing thresholds, middle ear function, complication rate, health related quality of life as well as the guardians’ evaluations of the postoperative care. Discussion Results from the ConVenTu study are expected to contribute with knowledge necessary to develop evidence-based guidelines regarding the level of expertise for safe postoperative care for children after surgery with VTs.

Download Full-text

Managing persistent wound leakage after total knee and hip arthroplasty. Results of a nationwide survey among Dutch orthopaedic surgeons

Journal of Bone and Joint Infection ◽

10.7150/jbji.22327 ◽

2017 ◽

Vol 2 (4) ◽

pp. 202-207 ◽

Cited By ~ 3

Author(s):

Frank-Christiaan Wagenaar ◽

Claudia A.M. Löwik ◽

Martin Stevens ◽

Sjoerd K. Bulstra ◽

Yvette Pronk ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Clinical Practice ◽

Controlled Trial ◽

Joint Arthroplasty ◽

Diagnosis And Treatment ◽

Evidence Based ◽

Randomized Controlled ◽

Multicenter Randomized Controlled Trial ◽

Maximum Period ◽

Wound Leakage

Abstract. Background: Persistent wound leakage after joint arthroplasty is a scantily investigated topic, despite the claimed relation with a higher risk of periprosthetic joint infection. This results in a lack of evidence-based clinical guidelines for the diagnosis and treatment of persistent wound leakage after joint arthroplasty. Without such guideline, clinical practice in orthopaedic hospitals varies widely. In preparation of a nationwide multicenter randomized controlled trial on the optimal treatment of persistent wound leakage, we evaluated current Dutch orthopaedic care for persistent wound leakage after joint arthroplasty.Methods: We conducted a questionnaire-based online survey among all 700 members of the Netherlands Orthopaedic Association, consisting of 23 questions on the definition, classification, diagnosis and treatment of persistent wound leakage after joint arthroplasty.Results: The questionnaire was completed by 127 respondents, representing 68% of the Dutch hospitals that perform orthopaedic surgery. The results showed wide variation in the classification, definition, diagnosis and treatment of persistent wound leakage among Dutch orthopaedic surgeons. 56.7% of the respondents used a protocol for diagnosis and treatment of persistent wound leakage, but only 26.8% utilized the protocol in every patient. Most respondents (59.1%) reported a maximum period of persistent wound leakage before starting non-surgical treatment of 3 to 7 days after index surgery and 44.1% of respondents reported a maximum period of wound leakage of 10 days before converting to surgical treatment.Conclusions: The wide variety in clinical practice underscores the importance of developing an evidence-based clinical guideline for the diagnosis and treatment of persistent wound leakage after joint arthroplasty. To this end, a nationwide multicenter randomized controlled trial will be conducted in the Netherlands, which may provide evidence on this important and poorly understood topic.

Download Full-text