Multicultural Aspects Affecting Patient-Doctor Interactions and the Conduct of Clinical Research Examples Drawn from the Literature and First-Hand Knowledge

Interest in international multicenter clinical trials is increasing for a variety of reasons. Working with different cultures in clinical research creates its own unique set of problems. This paper focuses on these issues from multicenter and multicultural perspectives.The influence of culture on patient-doctor communication is considered. Expectations and the use of outcomes measurements with different cultures are also explored. Details on the issue of pain and how it is expressed and measured in different cultures is also presented.Having considered the patient-doctor dynamic, the paper concludes with an examination of the unique difficulties that international multicenter studies present. Multicultural differences manifest themselves in different forms in international clinical research. Although its impact is often ignored or minimized, this manuscript demonstrates that the impact of culture on a study's success is a very real issue.In addition to secondary sources, examples from our own clinical investigations are outlined throughout this paper. A successful model to locate researchers in previously untapped countries is also outlined

Patient-reported outcomes feedback report for knee arthroplasty patients should present selective information in a simple design - findings of a qualitative study

BACKGROUND: Technical innovation to assess patient-reported outcomes (PROs) facilitates their implementation in clinical practice. In particular, mobile applications (apps) allow PROs to be assessed outside of the clinical setting. A patient\u27s health status can be remotely monitored and evaluated after discharge, and their recovery process tracked. This is of particular interest for patients after knee arthroplasty, as the recovery phase after surgery usually takes place in an outpatient setting and requires a high level of patient engagement. Providing results of PRO assessments to patients in the form of a feedback report could increase patient engagement and may improve communication between health care professionals and patients. The aim of the study is to develop a PRO feedback report for mobile devices that is comprehensible and provides valuable information for patients after knee arthroplasty. RESULTS: In an iterative development process, our expert group developed two preliminary feedback reports (a text-based version and a graphical display) based on previous research results and practical experience. In a second step, we discussed these reports with orthopedic patients (n = 8) in terms of comprehensibility and value using semi-structured interviews and cognitive debriefing methods. Participants assessed the reports as informative, but had some difficulties in fully comprehending all of the information provided. Based on the feedback from patients, we modified both versions and reduced complexity to increase comprehensibility. CONCLUSIONS: A PRO feedback report for patients for mobile app use has to take account of the heterogeneous user group, particularly demographics such as age and experience with mobile devices. Information should be presented in a simple way to be comprehensible and of value to patients. Technological advancements allow a simple default report to be set, something which enables patients interested in additional information to make customizations

Awareness, Attitudes, and Perceptions of Croatian-Based Orthopedic and Trauma Surgeons toward Scientific Manuscripts, Publishing Internationally and Medical Writing. Results of an Online Questionnaire

The objective of this survey was to identify the importance placed by Croatian-based surgeons on writing scientific manuscripts and publishing them internationally, as well as their awareness of and attitudes toward medical writing. A link to an online survey was sent to 327 Croatian-based orthopedic and trauma surgeons. The electronic questionnaire consisted of rating scales, multiple choice questions and free text reply boxes. A total of 61 surgeons based in Croatia replied to the survey, yielding a response rate of 19% (61/327). The survey results indicate that surgeons in Croatia are active in both research and the writing of manuscripts. There is also a high level of interest among them to publish internationally in English to further their careers. While 68% (38/56) of respondents initially claimed to know about medical writing, further questioning on the subject revealed a reduced level of familiarity with the concept. Only 19% (11/58) of respondents had ever engaged the services of a medical writer and they were generally satisfied with the work done across the three areas of language, editing and scientific knowledge. Medical writers are advised to increase awareness of their services among Croatian-based orthopedic and trauma surgeons who may well have a need for their expertise

Mangled Extremity – Case Report, Literature Review and Borderline Cases Guidelines Proposal

Treatment of a mangled lower extremity represents a major challenge. The decision whether to amputate or attempt reconstruction is currently based upon surgical evaluation. The aim of this paper is to propose a new approach to surgical evaluation based on scoring systems, local clinical status of the patient as well as comorbidities, mechanism of trauma and hospital resources. Available literature regarding this topic was evaluated and a case of patient with mangled extremity is presented. Based on current literature guidelines and evidence-based medicine, management for borderline cases is proposed to aid clinical decision making in these situations. We describe a 44-year old male patient who presented with mangled lower left leg. Despite a borderline Mangled Extremity Severity Score (MESS), due to the overall health status of the patient and local clinical status with preserved plantar sensitivity and satisfactory capillary perfusion, reconstruction was attempted. After 6 months of treatment, all wounds healed completely with no pain, and satisfactory motor and sensory function was achieved. In conclusion, the treatment of mangled extremity treatment should be based on evidence based literature along with a clinical evaluation of every individual patient. Scores are helpful, but should not be taken as the sole indication for amputation

The advantages of electronic patient-reported measures and an example digital platform to collect ePROs after total knee arthroplasty

The patient’s perspective is increasingly being sought out in measuring the success of a medical procedure. Patient-reported outcome measures (PROMs) are the tools used to elicit patient options. Despite increased popularity, issues still remain around their use. Electronic PROMs have been suggested as an improvement on paper-based collection of data. Begun in 2004, the US-initiated Patient-Reported Outcome Measurement Information System (PROMIS ® ) aims to improve the standards for the assessment of self-reported health status. The PROMIS initiative has generated a reliable and sensitive system, customised to the patient, which poses as few questions as possible. This is achieved through the use of computer-adaptive tests (CATs), which are individually tailored electronic questionnaires. Smith & Nephew collaborated with Wellframe Inc., a US-based patented health management solution, to adapt their platform for total knee arthroplasty patients and PROMIS CAT data collection. The platform’s app can be used outside of scheduled clinic visits to collect data from patients. This enables orthopaedic surgeons, for the first time, to remotely track their patients’ real-time healing progress and satisfaction levels. Smith & Nephew is currently investigating the use of this application for clinical research purposes. If electronic PROMs deliver on their promise, there is great potential to introduce them to the many clinical studies that the company runs and/or funds

Indications for bi-cruciate retaining total knee replacement: An international survey of 346 knee surgeons

There is limited evidence on total knee arthroplasty (TKA) that retains the anterior and the posterior cruciate ligaments. Bi-cruciate retaining (BCR) TKA is considered to show improved clinical function and kinematics. This survey aimed to (1) identify interest in and acceptance of BCR TKA surgery and (2) to capture the range of indications for BCR in the opinion of practicing knee surgeons. 346 surgeons with experience in TKA surgery completed a bi-lingual online survey. Demographics, arthroplasty experience as well as acceptance of and indications for BCR TKA were collected. 53 surgeons were experienced in BCR TKA and 225 would consider implanting it. A mean of 19.5% of TKA patients were considered eligible for BCR TKA. 56.3% were thought to have intact ACL at the time of TKA surgery. Surgeons were not likely to perform BCR TKA in patients with inflammatory arthritis, aged over 80, BMI above 34.9 kg/m(2), a varus or valgus deformity of more than 10 degrees and flexion contractures of more than 10 degrees. There is strong interest among orthopedic surgeons to perform BCR TKA and the percentage of potentially eligible patients is high. Significant joint deformity is a limitation of BCR TKA, while age and high BMI are less relevant. BCR TKA experienced surgeons are less restrictive

Education and training for entrepreneurs: a consideration of initiatives in Ireland and The Netherlands

A growing body of academic research has examined the effectiveness of entrepreneurship training and support initiatives, with recent studies focusing on the provision of training and other skills development opportunities. An important theme that has emerged from this work is the failure of many programmes and initiatives to take on board the particular needs of the entrepreneurs in developing training and support systems. By extending research in this area, this article considers the importance of education and training to the economy and focuses on the particular value of entrepreneurship education and training. Some of the fundamental themes in the literature are reviewed, including the difficulties involved in categorising entrepreneurship education and training; the issue of whether or not entrepreneurship can be taught; the content of entrepreneurship programmes and the cultural and evaluative considerations. The article discusses and compares training and support provision for entrepreneurs in Ireland and The Netherlands.\ud \u

Bi-cruciate retaining total knee arthroplasty: a systematic literature review of clinical outcomes

Total knee arthroplasty (TKA) has been shown to have good long-term outcomes and survivorship. Nonetheless, dissatisfied patients are frequently reported in the literature. Bi-cruciate retaining total knee prostheses (BCR TKA) were designed to address the demand for more kinematically functional implants that better reconstruct natural knee kinematics. In BCR TKA, the anterior cruciate ligament (ACL) is preserved. Improved patient-reported outcomes and satisfaction levels are expected. This review aimed to summarize indications for and clinical outcomes of BCR TKA. A systematic literature review on BCR TKA was performed. 24 articles were included for data analysis. Indications covered osteoarthritis, inflammatory arthritis and others. The degree of deformity was often but not always limited to minor axial deformity and contractures: maximum acceptable varus/valgus deformity reached 10 degrees-30 degrees and flexion contractures of 15 degrees-65 degrees. ACL intactness was macroscopically examined intraoperatively in nine studies and clinically tested in ten studies (e.g., Lachmann Test, drawer-test). Objective and patient-reported outcome scores were reported for follow-up periods of up to 22 years. Survival rates varied significantly. For first generation implants, 22-year survival reached 82% while a second generation design was associated with 13.5% revision rate at 18 months. Reasons for varying outcomes were not clear and may be attributed to the implant itself, surgical techniques and patient specific variables including changed expectations and functional demand. The literature has not shown clear indications and guidelines for the use of BCR implants. The promising results of first generation BCR TKA designs may be optimized through improved implant designs in the future. Further studies are advocated to provide the necessary evidence of second generation BCR TKA designs