Pub Date : 2003-12-01DOI: 10.1080/00016470310018108
Seppo Santavirta
Particulate wear debris in totally replaced hips causes adverse local host reactions. The extreme form of such a reaction, aggressive granulomatosis, was found to be a distinct condition and different from simple aseptic loosening. Reactive and adaptive tissues around the totally replaced hip were made of proliferation of local fibroblast like cells and activated macrophages. Methylmethacrylate and high-molecular-weight polyethylene were shown to be essentially immunologically inert implant materials, but in small particulate form functioned as cellular irritants initiating local biological reactions leading to loosening of the implants. Chromium-cobalt-molybdenum is the most popular metallic implant material; it is hard and tough, and the bearings of this metal are partially self-polishing. In total hip implants, prerequisites for longevity of the replaced hip are good biocompatibility of the materials and sufficient tribological properties of the bearings. The third key issue is that the bearing must minimize frictional shear at the prosthetic bone-implant interface to be compatible with long-term survival. Some of the approaches to meet these demands are alumina-on-alumina and metal-on-metal designs, as well as the use of highly crosslinked polyethylene for the acetabular component. In order to avoid the wear-based deleterious properties of the conventional total hip prosthesis materials or coatings, the present work included biological and tribological testing of amorphous diamond. Previous experiments had demonstrated that a high adhesion of tetrahedral amorphous carbon coatings to a substrate can be achieved by using mixing layers or interlayers. Amorphous diamond was found to be biologically inert, and simulator testing indicated excellent wear properties for conventional total hip prostheses, in which either the ball or both bearing surfaces were coated with hydrogen-free tetrahedral amorphous diamond films. Simulator testing with such total hip prostheses showed no measurable wear or detectable delamination after 15,000,000 test cycles corresponding to 15 years of clinical use. The present work clearly shows that wear is one of the basic problems with totally replaced hips. Diamond coating of the bearing surfaces appears to be an attractive solution to improve longevity of the totally replaced hip.
{"title":"Compatibility of the totally replaced hip. Reduction of wear by amorphous diamond coating.","authors":"Seppo Santavirta","doi":"10.1080/00016470310018108","DOIUrl":"https://doi.org/10.1080/00016470310018108","url":null,"abstract":"<p><p>Particulate wear debris in totally replaced hips causes adverse local host reactions. The extreme form of such a reaction, aggressive granulomatosis, was found to be a distinct condition and different from simple aseptic loosening. Reactive and adaptive tissues around the totally replaced hip were made of proliferation of local fibroblast like cells and activated macrophages. Methylmethacrylate and high-molecular-weight polyethylene were shown to be essentially immunologically inert implant materials, but in small particulate form functioned as cellular irritants initiating local biological reactions leading to loosening of the implants. Chromium-cobalt-molybdenum is the most popular metallic implant material; it is hard and tough, and the bearings of this metal are partially self-polishing. In total hip implants, prerequisites for longevity of the replaced hip are good biocompatibility of the materials and sufficient tribological properties of the bearings. The third key issue is that the bearing must minimize frictional shear at the prosthetic bone-implant interface to be compatible with long-term survival. Some of the approaches to meet these demands are alumina-on-alumina and metal-on-metal designs, as well as the use of highly crosslinked polyethylene for the acetabular component. In order to avoid the wear-based deleterious properties of the conventional total hip prosthesis materials or coatings, the present work included biological and tribological testing of amorphous diamond. Previous experiments had demonstrated that a high adhesion of tetrahedral amorphous carbon coatings to a substrate can be achieved by using mixing layers or interlayers. Amorphous diamond was found to be biologically inert, and simulator testing indicated excellent wear properties for conventional total hip prostheses, in which either the ball or both bearing surfaces were coated with hydrogen-free tetrahedral amorphous diamond films. Simulator testing with such total hip prostheses showed no measurable wear or detectable delamination after 15,000,000 test cycles corresponding to 15 years of clinical use. The present work clearly shows that wear is one of the basic problems with totally replaced hips. Diamond coating of the bearing surfaces appears to be an attractive solution to improve longevity of the totally replaced hip.</p>","PeriodicalId":75404,"journal":{"name":"Acta orthopaedica Scandinavica. Supplementum","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2003-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/00016470310018108","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24202275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The worldwide increase in hip fractures is a major challenge to the health care system and society. The proper treatment of femoral neck fractures in the elderly is still controversial, and even more so from an international perspective. Optimising the treatment for improved outcomes and a reduced need for secondary surgery is mandatory for humanitarian and economical reasons. The importance of incorporating the patient's perspective of the outcome in clinical trials has been acknowledged and there are now numerous instruments for assessing the quality of life. We evaluated two quality of life instruments, the EQ-5D and the SF-36, in patients with femoral neck fractures and also measured the quality of life two years after different interventions. The EQ-5D was validated in two prospective studies and it appeared to be an appropriate quality of life instrument in elderly patients with femoral neck fractures. There was a good correlation between the quality of life (EQ-5Dindexscores) and other outcome measures such as pain, mobility and independence in activities of daily living (ADL). The results also showed high responsiveness, i.e., ability to capture clinically important changes, for both the EQ-5D and the SF-36. The questionnaire response rate for both instruments was high. The rated prefracture EQ-5Dindexscores showed good correspondence with the scores of an age-matched Swedish reference population. The quality of life in patients with femoral neck fractures treated with internal fixation (IF) decreased, particularly in patients with fracture healing complications. The fracture healing complications rate at two years in patients with displaced femoral neck fractures treated with IF was 36% compared with 7% in patients with undisplaced fractures. The quality of life of patients with uneventfully healed fractures at two year was lower in patients with primary displaced fractures than in patients with primary undisplaced fractures. In a prospective randomised trial, patients with displaced femoral neck fractures were randomised to IF or total hip replacement (THR). IF resulted in more complications than THR, 36% versus 4%, and necessitated more reoperations, 42% versus 4%. Hip function and quality of life (EQ-5D) were generally better in the THR group. In summary, THR yielded a better outcome than IF for an elderly, relatively healthy, lucid patient with a displaced femoral neck fracture. In a study of elderly women with femoral neck fractures, nearly half of the patients displayed signs of protein-energy malnutrition. Underweight was associated with muscle fatigue, cognitive dysfunction and a low quality of life (Nottingham Health Profile). In a prospective randomised trial, protein-rich liquid supplementation in combination with an anabolic steroid given for 6 months to lean elderly women after a femoral neck fracture was shown to positively affect lean body mass, ADL and quality of life (EQ-5D). Fracture healing complications had a ne
{"title":"Quality of life and femoral neck fractures.","authors":"Jan Tidermark","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The worldwide increase in hip fractures is a major challenge to the health care system and society. The proper treatment of femoral neck fractures in the elderly is still controversial, and even more so from an international perspective. Optimising the treatment for improved outcomes and a reduced need for secondary surgery is mandatory for humanitarian and economical reasons. The importance of incorporating the patient's perspective of the outcome in clinical trials has been acknowledged and there are now numerous instruments for assessing the quality of life. We evaluated two quality of life instruments, the EQ-5D and the SF-36, in patients with femoral neck fractures and also measured the quality of life two years after different interventions. The EQ-5D was validated in two prospective studies and it appeared to be an appropriate quality of life instrument in elderly patients with femoral neck fractures. There was a good correlation between the quality of life (EQ-5Dindexscores) and other outcome measures such as pain, mobility and independence in activities of daily living (ADL). The results also showed high responsiveness, i.e., ability to capture clinically important changes, for both the EQ-5D and the SF-36. The questionnaire response rate for both instruments was high. The rated prefracture EQ-5Dindexscores showed good correspondence with the scores of an age-matched Swedish reference population. The quality of life in patients with femoral neck fractures treated with internal fixation (IF) decreased, particularly in patients with fracture healing complications. The fracture healing complications rate at two years in patients with displaced femoral neck fractures treated with IF was 36% compared with 7% in patients with undisplaced fractures. The quality of life of patients with uneventfully healed fractures at two year was lower in patients with primary displaced fractures than in patients with primary undisplaced fractures. In a prospective randomised trial, patients with displaced femoral neck fractures were randomised to IF or total hip replacement (THR). IF resulted in more complications than THR, 36% versus 4%, and necessitated more reoperations, 42% versus 4%. Hip function and quality of life (EQ-5D) were generally better in the THR group. In summary, THR yielded a better outcome than IF for an elderly, relatively healthy, lucid patient with a displaced femoral neck fracture. In a study of elderly women with femoral neck fractures, nearly half of the patients displayed signs of protein-energy malnutrition. Underweight was associated with muscle fatigue, cognitive dysfunction and a low quality of life (Nottingham Health Profile). In a prospective randomised trial, protein-rich liquid supplementation in combination with an anabolic steroid given for 6 months to lean elderly women after a femoral neck fracture was shown to positively affect lean body mass, ADL and quality of life (EQ-5D). Fracture healing complications had a ne","PeriodicalId":75404,"journal":{"name":"Acta orthopaedica Scandinavica. Supplementum","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2003-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22442150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2003-02-01DOI: 10.1080/03008820310014109
Henrik Lauge-Pedersen
It has been generally accepted that residual cartilage and subchondral bone has to be removed in order to get bony fusion in arthrodeses. In 1998 we reported successful fusion of 11 rheumatoid ankles, all treated with percutaneous fixation only. In at least one of these ankle joint there was cartilage left. This was confirmed by arthrotomy in order to remove an osteophyte, which hindered dorsiflexion. More than 25 rheumatoid patients with functional alignment in the ankle joint have subsequently been operated on with the percutaneous technique, and so far we have had only one failure. Patients with rheumatoid arthritis are known to sometimes fuse at least their subtalar joints spontaneously, and the destructive effect of the synovitis on the cartilage could contribute to fusion when using the percutaneous technique. In a rabbit study we therefore tested the hypothesis that even a normal joint can fuse merely by percutaneous fixation. The patella was fixated to the femur with lag screw technique without removal of cartilage, and in 5 of 6 arthrodeses with stable fixation bony fusion followed. Depletion of synovial fluid seemed to be the mechanism behind cartilage disappearance. The stability of the fixation achieved at arthrodesis surgery is an important factor in determining success or failure. Dowel arthrodesis without additional fixation proved to be deleterious. A good fit of the bone surfaces appears necessary. In the ankle joint, it would be technically demanding to retain the arch-shaped geometry of the joint after resection of the cartilage. Normally the joint surfaces are resected to produce flat osteotomy surfaces that are thus easier to fit together, encouraging healing to occur. On the other hand it is considered an advantage to preserve as much subchondral bone as possible, as the strong subchondral bone plate can contribute to the stability of the arthrodesis. Ankle arthrodesis can be successfully performed in patients with rheumatoid arthritis by percutaneous screw fixation without resection of the joint surfaces. This procedure has two advantages: first, it is less surgically traumatic, second, both the arch-shaped geometry and the subchondral bone are preserved, and thus both could contribute to the postoperative stability of the construct. Intuitively, preservation of the arch-shape should increase rotational stability. The results of our experimental sawbone study indicate that the arch shape and the subchondral bone should be preserved when ankle arthrodesis is performed. The importance of this is likely to increase in weak rheumatoid bone. In a finite element study the initial stability provided by two different methods of joint preparation and different screw configurations in ankle arthrodesis, was compared. Better initial stability is predicted for ankle arthrodesis when joint contours are preserved rather than resected. Overall, inserting the two screws at a 30-degree angle with respect to the long axis of the tibia
{"title":"Percutaneous arthrodesis.","authors":"Henrik Lauge-Pedersen","doi":"10.1080/03008820310014109","DOIUrl":"https://doi.org/10.1080/03008820310014109","url":null,"abstract":"<p><p>It has been generally accepted that residual cartilage and subchondral bone has to be removed in order to get bony fusion in arthrodeses. In 1998 we reported successful fusion of 11 rheumatoid ankles, all treated with percutaneous fixation only. In at least one of these ankle joint there was cartilage left. This was confirmed by arthrotomy in order to remove an osteophyte, which hindered dorsiflexion. More than 25 rheumatoid patients with functional alignment in the ankle joint have subsequently been operated on with the percutaneous technique, and so far we have had only one failure. Patients with rheumatoid arthritis are known to sometimes fuse at least their subtalar joints spontaneously, and the destructive effect of the synovitis on the cartilage could contribute to fusion when using the percutaneous technique. In a rabbit study we therefore tested the hypothesis that even a normal joint can fuse merely by percutaneous fixation. The patella was fixated to the femur with lag screw technique without removal of cartilage, and in 5 of 6 arthrodeses with stable fixation bony fusion followed. Depletion of synovial fluid seemed to be the mechanism behind cartilage disappearance. The stability of the fixation achieved at arthrodesis surgery is an important factor in determining success or failure. Dowel arthrodesis without additional fixation proved to be deleterious. A good fit of the bone surfaces appears necessary. In the ankle joint, it would be technically demanding to retain the arch-shaped geometry of the joint after resection of the cartilage. Normally the joint surfaces are resected to produce flat osteotomy surfaces that are thus easier to fit together, encouraging healing to occur. On the other hand it is considered an advantage to preserve as much subchondral bone as possible, as the strong subchondral bone plate can contribute to the stability of the arthrodesis. Ankle arthrodesis can be successfully performed in patients with rheumatoid arthritis by percutaneous screw fixation without resection of the joint surfaces. This procedure has two advantages: first, it is less surgically traumatic, second, both the arch-shaped geometry and the subchondral bone are preserved, and thus both could contribute to the postoperative stability of the construct. Intuitively, preservation of the arch-shape should increase rotational stability. The results of our experimental sawbone study indicate that the arch shape and the subchondral bone should be preserved when ankle arthrodesis is performed. The importance of this is likely to increase in weak rheumatoid bone. In a finite element study the initial stability provided by two different methods of joint preparation and different screw configurations in ankle arthrodesis, was compared. Better initial stability is predicted for ankle arthrodesis when joint contours are preserved rather than resected. Overall, inserting the two screws at a 30-degree angle with respect to the long axis of the tibia ","PeriodicalId":75404,"journal":{"name":"Acta orthopaedica Scandinavica. Supplementum","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2003-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/03008820310014109","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22292291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2003-02-01DOI: 10.1080/000164702760300006
Carina Forslund
We wanted to improve tendon healing by adding a growth factor. Bone Morphogenetic Proteins (BMPs) are well known to stimulate bone healing and bone formation. The local environment is of major importance for cell differentiation after a BMP has been added. Cartilage Derived Morphogenetic Proteins (CDMPs) -1, -2 and -3 (BMP 14, 13 and 12 or GDF 5, 6 and 7) form a subgroup in the BMP-family and are closely related to OP-1 (BMP 7). CDMP implants have been shown to induce bone and cartilage as well as tendon and ligament-like tissue. Our hypothesis has therefore been that if a BMP were added in a tendon environment, a tendon-like tissue would be induced. We have developed models in rats and rabbits where the Achilles tendon is transsected. To influence tendon healing, different BMPs (OP-1, CDMP-1. -2 and -3) were added, either on a collagen carrier, or as a local injection into the tendon defect. The tendons were evaluated by histology and mechanical testing at different time-points after transection. The results show that also when the mechanical environment would favour the formation of a tendon-like tissue, OP-1 reduced tendon strength in aid of bone formation. In contrast, CDMP-1, -2 and -3 had a beneficial effect upon tendon healing in rats. More callus tissue was produced than in controls, and strength and stiffness were improved, although minor amounts of bone and cartilage were detected in the tendon callus. Cartilage and bone formation sometimes occur normally during Achilles tendon healing in rats. In the rabbit model, where the healing situation is more similar to the clinical situation, the positive result with CDMP-2 was repeated. Moreover, in rabbits no bone or cartilage was found. The results suggest that conservative treatment of Achilles tendon ruptures with injection of a CDMP in combination with early rehabilitation might afford a good alternative to surgical treatment.
{"title":"BMP treatment for improving tendon repair. Studies on rat and rabbit Achilles tendons.","authors":"Carina Forslund","doi":"10.1080/000164702760300006","DOIUrl":"https://doi.org/10.1080/000164702760300006","url":null,"abstract":"We wanted to improve tendon healing by adding a growth factor. Bone Morphogenetic Proteins (BMPs) are well known to stimulate bone healing and bone formation. The local environment is of major importance for cell differentiation after a BMP has been added. Cartilage Derived Morphogenetic Proteins (CDMPs) -1, -2 and -3 (BMP 14, 13 and 12 or GDF 5, 6 and 7) form a subgroup in the BMP-family and are closely related to OP-1 (BMP 7). CDMP implants have been shown to induce bone and cartilage as well as tendon and ligament-like tissue. Our hypothesis has therefore been that if a BMP were added in a tendon environment, a tendon-like tissue would be induced.\u0000\u0000We have developed models in rats and rabbits where the Achilles tendon is transsected. To influence tendon healing, different BMPs (OP-1, CDMP-1. -2 and -3) were added, either on a collagen carrier, or as a local injection into the tendon defect. The tendons were evaluated by histology and mechanical testing at different time-points after transection.\u0000\u0000The results show that also when the mechanical environment would favour the formation of a tendon-like tissue, OP-1 reduced tendon strength in aid of bone formation. In contrast, CDMP-1, -2 and -3 had a beneficial effect upon tendon healing in rats. More callus tissue was produced than in controls, and strength and stiffness were improved, although minor amounts of bone and cartilage were detected in the tendon callus. Cartilage and bone formation sometimes occur normally during Achilles tendon healing in rats. In the rabbit model, where the healing situation is more similar to the clinical situation, the positive result with CDMP-2 was repeated. Moreover, in rabbits no bone or cartilage was found.\u0000\u0000The results suggest that conservative treatment of Achilles tendon ruptures with injection of a CDMP in combination with early rehabilitation might afford a good alternative to surgical treatment.","PeriodicalId":75404,"journal":{"name":"Acta orthopaedica Scandinavica. Supplementum","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2003-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/000164702760300006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22292001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Abstracts of the IVth Baltic Bone and Cartilage Conference. Binz, Germany, 4-8 September 2002.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":75404,"journal":{"name":"Acta orthopaedica Scandinavica. Supplementum","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2002-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22138077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-10-01DOI: 10.1080/000164702760379558
Helen H G Handoll, Rajan Madhok
adults. We undertook 2 systematic reviews with the support of the Cochrane Musculoskeletal Injuries Group (CMSIG); one of the 50 Collaborative Review Groups covering various aspects of health care in the Cochrane Collaboration. The latter international, not-for-proe t organization aims to help people make well-informed decisions about healthcare by preparing, maintaining and promoting the accessibility of systematic reviews of the effects of healthcare interventions. Further information can be obtained from the Collaboration’s World Wide Web site: http://www.cochrane.org.
{"title":"Managing fractures of the distal radius in adults. Clinical and research implications from systematic reviews of existing trials.","authors":"Helen H G Handoll, Rajan Madhok","doi":"10.1080/000164702760379558","DOIUrl":"https://doi.org/10.1080/000164702760379558","url":null,"abstract":"adults. We undertook 2 systematic reviews with the support of the Cochrane Musculoskeletal Injuries Group (CMSIG); one of the 50 Collaborative Review Groups covering various aspects of health care in the Cochrane Collaboration. The latter international, not-for-proe t organization aims to help people make well-informed decisions about healthcare by preparing, maintaining and promoting the accessibility of systematic reviews of the effects of healthcare interventions. Further information can be obtained from the Collaboration’s World Wide Web site: http://www.cochrane.org.","PeriodicalId":75404,"journal":{"name":"Acta orthopaedica Scandinavica. Supplementum","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2002-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/000164702760379558","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22211857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Proceedings of the First International Meeting on EBM in Musculoskeletal Disorders (e_Musk1). Ferrara, Italy, April 2001.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":75404,"journal":{"name":"Acta orthopaedica Scandinavica. Supplementum","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2002-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22211847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-10-01DOI: 10.1080/000164702760379486
Vivian Robinson, Peter Tugwell, Maria Judd, Beverley Shea, George Wells
The evidence-based medicine research community is increasingly recognizing that the translation of evidence into clinical practice is an important research agenda. This paper describes research methods related to transferring knowledge to different audiences: clinicians, consumers and policymakers. The iterative measurement loop (IML) described in 1987 (Tugwell 1987) highlights the 6 steps of evidence-based research that leads to the translation of evidence into practice and re-evaluation of the impact of evidence-based medicine (Figure 1). This paper describes research methods for assessing steps of the IML with the goal of improving knowledge translation and uptake of evidence-based medicine. Evidence-based medicine has been de ned as the process of systematically nding, appraising, and using contemporaneous research ndings as the basis for clinical decisions. Evidence-based medicine asks questions, nds and appraises the relevant data, and harnesses that information for everyday clinical practice. Evidence-based medicine follows four steps: formulate a clear clinical question from a patient’s problem; search the literature for relevant clinical articles; evaluate (critically appraise) the evidence for its validity and usefulness; implement useful ndings in clinical practice (Rosenberg 1995) The challenge of evidence-based medicine is to allow clinicians and consumers to quantify the impact of an intervention on individual patients. Research methodology in rheumatology
{"title":"Research methodology in rheumatology.","authors":"Vivian Robinson, Peter Tugwell, Maria Judd, Beverley Shea, George Wells","doi":"10.1080/000164702760379486","DOIUrl":"https://doi.org/10.1080/000164702760379486","url":null,"abstract":"The evidence-based medicine research community is increasingly recognizing that the translation of evidence into clinical practice is an important research agenda. This paper describes research methods related to transferring knowledge to different audiences: clinicians, consumers and policymakers. The iterative measurement loop (IML) described in 1987 (Tugwell 1987) highlights the 6 steps of evidence-based research that leads to the translation of evidence into practice and re-evaluation of the impact of evidence-based medicine (Figure 1). This paper describes research methods for assessing steps of the IML with the goal of improving knowledge translation and uptake of evidence-based medicine. Evidence-based medicine has been de ned as the process of systematically nding, appraising, and using contemporaneous research ndings as the basis for clinical decisions. Evidence-based medicine asks questions, nds and appraises the relevant data, and harnesses that information for everyday clinical practice. Evidence-based medicine follows four steps: formulate a clear clinical question from a patient’s problem; search the literature for relevant clinical articles; evaluate (critically appraise) the evidence for its validity and usefulness; implement useful ndings in clinical practice (Rosenberg 1995) The challenge of evidence-based medicine is to allow clinicians and consumers to quantify the impact of an intervention on individual patients. Research methodology in rheumatology","PeriodicalId":75404,"journal":{"name":"Acta orthopaedica Scandinavica. Supplementum","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2002-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/000164702760379486","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22211850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-10-01DOI: 10.1080/000164702760379521
R P Pitto, I Lang, H Kienapfel, H-G Willert
Since 1989, as a result of the Health Reform Act, German hospitals have been obliged to participate in measures for external quality assurance. The objective is to document and assess selected services—including the use and check of artie cial hips and knee joints—within the framework of quality assurance measures. The organisation of this documentation was transferred to the Quality Assurance Ofe ce (Servicestelle Qualitatssicherung, SQS) in Dusseldorf. Documentation started in some States (Lander) in 1997. Despite the extensive and expensive SQS documentation in the area of arthroplasty, however, the project did not fule l the expectations (Griss 1998). A new organisation, the Bundesgeschaftsstelle fur Qualitatssicherung (BQS) recently started a new documentation project, but the structure for the analysis of data does not exist at the moment, and it is unknown how this will be achieved. The Verein EndoprothesenRegister was founded in 1994 with the objective of quality assurance for members of the biomaterial working group of the German Society of Orthopaedics and Traumatology (Deutsche Gesellschaft fur Orthopadie und Traumatologie), the association of surgeons for biomaterials of the German Society of Surgery (Deutsche Gesellschaft fur Chirurgie) and the German Society of Trauma Surgery (Deutsche Gesellschaft fur Unfallchirurgie), as well as representatives of the industry. In 1997, the association started to set up an arthroplasty register based on the Scandinavian model (Lang and Willert 2001).
{"title":"The German Arthroplasty Register.","authors":"R P Pitto, I Lang, H Kienapfel, H-G Willert","doi":"10.1080/000164702760379521","DOIUrl":"https://doi.org/10.1080/000164702760379521","url":null,"abstract":"Since 1989, as a result of the Health Reform Act, German hospitals have been obliged to participate in measures for external quality assurance. The objective is to document and assess selected services—including the use and check of artie cial hips and knee joints—within the framework of quality assurance measures. The organisation of this documentation was transferred to the Quality Assurance Ofe ce (Servicestelle Qualitatssicherung, SQS) in Dusseldorf. Documentation started in some States (Lander) in 1997. Despite the extensive and expensive SQS documentation in the area of arthroplasty, however, the project did not fule l the expectations (Griss 1998). A new organisation, the Bundesgeschaftsstelle fur Qualitatssicherung (BQS) recently started a new documentation project, but the structure for the analysis of data does not exist at the moment, and it is unknown how this will be achieved. The Verein EndoprothesenRegister was founded in 1994 with the objective of quality assurance for members of the biomaterial working group of the German Society of Orthopaedics and Traumatology (Deutsche Gesellschaft fur Orthopadie und Traumatologie), the association of surgeons for biomaterials of the German Society of Surgery (Deutsche Gesellschaft fur Chirurgie) and the German Society of Trauma Surgery (Deutsche Gesellschaft fur Unfallchirurgie), as well as representatives of the industry. In 1997, the association started to set up an arthroplasty register based on the Scandinavian model (Lang and Willert 2001).","PeriodicalId":75404,"journal":{"name":"Acta orthopaedica Scandinavica. Supplementum","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2002-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/000164702760379521","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22211854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}