Broad-spectrum Antibiotic Prophylaxis in Tumor and Infected Orthopedic Surgery - the prospective-randomized, microbiologist-blinded, stratified, superiority Trials - BAPTIST trials

Background: The perioperative antibiotic prophylaxis with 1st or 2nd-generation cephalosporins is evidence-based in orthopedic surgery. There are, however, situations with a high risk of prophylaxis-resistant surgical site infections (SSI). Methods: We perform a superiority randomized-controlled trial with a 10% margin and a power of 90% in favor of the broad-spectrum prophylaxis. We will randomize orthopedic interventions with a high risk for SSI (open fractures, surgery under therapeutic antibiotics, tumor surgery, spine surgery with ASA-Score ≥ 3 points) in a prospective-alternating scheme (1:1, standard prophylaxis with mostly cefuroxime versus a broad-spectrum prophylaxis of a combined single-shot of vancomycin 1 g & gentamicin 5 mg/kg parenterally). The primary outcomes are "remission" at 6 weeks; or at 1 year for surgeries with implant. Secondary outcomes are the risk for prophylaxis-resistant SSI pathogens, revision surgery for any reason, change of antibiotic therapy, adverse events and the incidence of non-SSI infections within 6 weeks (e.g. urine infections). With event-free surgeries to 95% in the broad-spectrum versus 85% in the standard arm, we need 2 x 207 orthopedic surgeries among all groups. Discussion: In selected patients with a high risk for prophylaxis-resistant SSI, a broad-spectrum combination might prevent SSIs better than the standard prophylaxis. Trial registration: ClinicalTrial.gov NCT05502380. Registered on 12 August 2022. Protocol version: 2 (3 June 2022

Arthroscopic observation was useful to detect loosening of the femoral component of unicompartmental knee arthroplasty in a recurrent hemoarthrosis

A case of recurrent hemarthrosis of the knee after a mobile-bearing unicompartmental knee arthroplasty (UKA; Oxford UKA) is described. A 58-year-old man met with a road traffic accident 10 months after UKA. He developed anteromedial pain and hemarthrosis of the knee joint 1 month after the accident, which required multiple aspirations. Physical examination showed no instability. Plain radiograph revealed no signs of loosening. All laboratory data, including bleeding and coagulation times, were within normal limits. Diagnostic arthroscopy demonstrated loosening of the femoral component. Any intraarticular pathology other than nonspecific synovitis was ruled out. The loose femoral component and polyethylene meniscal bearing were revised. Since then, hemarthrosis has not recurred

Capturing complexity: Mixing methods in the analysis of a European tobacco control policy network

Social network analysis (SNA), a method which can be used to explore networks in various contexts, has received increasing attention. Drawing on the development of European smoke-free policy, this paper explores how a mixed method approach to SNA can be utilised to investigate a complex policy network. Textual data from public documents, consultation submissions and websites were extracted, converted and analysed using plagiarism detection software and quantitative network analysis, and qualitative data from public documents and 35 interviews were thematically analysed. While the quantitative analysis enabled understanding of the network's structure and components, the qualitative analysis provided in-depth information about specific actors' positions, relationships and interactions. The paper establishes that SNA is suited to empirically testing and analysing networks in EU policymaking. It contributes to methodological debates about the antagonism between qualitative and quantitative approaches and demonstrates that qualitative and quantitative network analysis can offer a powerful tool for policy analysis

The choice for EU theorists: Establishing a common framework for analysis

European Union (EU) studies have entered a highly contentious and, arguably, creative phase. A range of theoretical perspectives, seemingly quite highly differentiated from one another, now compete for influence and lsquospacersquo. However, the questions remain: is EU studies developing theories which are truly competing theories? Or is it developing theories that do not compete so much as they aim to explain distinctly different pieces of the EU puzzle? This paper responds directly to these two questions, while reviewing recent literature on EU governance. It argues, first, that we lack theories of EU governance that are true rivals; and, second, that leading models explain different outcomes at different levels in a multi-level system of governance. The result is somewhat phoney debates between compatible theories masquerading as rivals, and between lsquocomparative politicsrsquo and lsquointernational relationsrsquo approaches. Above all, perhaps, we find middle range theories posing as general or lsquometa-theoriesrsquo. In the absence of a plausible general theory of EU governance, theorists must choose precisely which type of outcome theywish to explain

Public perceptions of shale gas in the UK : framing effects and decision heuristics

Using two equivalent descriptions of the shale gas development process, we asked individuals to indicate their levels of support as well as their perceptions of the risks and costs involved. In version 1, shale gas development was framed as ‘fracking’, whereas under version 2 it was framed as ‘using hydraulic pressure to extract natural gas from the ground’. We find that individuals’ support for shale gas development is much lower when using the term ‘fracking’ as opposed to the synonymous descriptive term, and moreover, these differences were substantive. Our analysis suggests that these differences appear to be largely the result of different assessments of the risks associated with ‘fracking’ as opposed to ‘using hydraulic pressure to extract natural gas from the ground’. Our proposed explanation for these differences rests on the idea that shale gas development is a technical and complex process and many individuals will be bounded by the rationality of scientific knowledge when it comes to understanding this process. In turn, individuals may be relying on simple decision heuristics shaped by the way this issue is framed by the media and other interested parties which may constrain meaningful discourse on this topic with the public. Our findings also highlight some of the potential pitfalls when it comes to relying on survey research for assessing the public’s views towards complex environmental issues