Large variation in use of patient-reported outcome measures: A survey of 188 foot and ankle surgeons

Background: There is an increasing interest in the use of patient reported outcome measures (PROMs). However, there is a large variety of PROMs and a lack of consensus regarding preference for their use. Aim of this study is to determine how often PROMS are used for foot and ankle disorders, for what purpose PROMs are used, and what the preferences of the foot and ankle surgeons are, when choosing a PROM to use.Methods: Members of the Ankleplatform Study Group-Science of Variation Collaborative were invited to participate in this survey by email. The online survey consisted of six questions on the use and preferences regarding foot and ankle PROMs.Results: 188 participants completed the questionnaire. Of the respondents 17% reported not to use PROMs, 72% stated to use PROMS for research, 39% routinely for patient care and 34% for registration or quality assessment. The respondents were familiar with 30 different outcome measures, of which 20 were PROMs. One of the excluded outcome measures, the AOFAS Hindfoot scale was most commonly reported as preferred outcome measure. FAOS and MOXFQ were the preferred PROMs, reported by 9.7% of the surgeons. Subsequently followed by the FFI (4.3%), the FAAM (3.7%) and the VAS-FA (3.7%).Conclusions: A large majority of the foot and ankle surgeons uses PROMs. The AOFAS hindfoot scale is mentioned as the most preferred outcome measure, while in fact this is not a PROM. Of the twenty different PROMs mentioned in this study, most reported were the FAOS and MOXFQ both supported by only 9.7% of the surgeons. For proper comparison between patients in clinical practice and research, consensus is needed on which easy-to-use PROM with adequate clinimetric properties should be used. Therefore more evidence in the field of clinimetrics of foot and ankle outcome measures is needed. (C) 2017 Published by Elsevier Ltd on behalf of European Foot and Ankle Society

Surgical site infection after wound closure with staples versus sutures in elective knee and hip arthroplasty:a systematic review and meta-analysis

PURPOSE: This systematic review and meta-analysis aimed to study surgical site infection of wound closure using staples versus sutures in elective knee and hip arthroplasties. METHODS: A systematic literature review was performed to search for randomized controlled trials that compared surgical site infection after wound closure using staples versus sutures in elective knee and hip arthroplasties. The primary outcome was surgical site infection. The risk of bias was assessed with the Cochrane risk of bias assessment tool. The relative risk and 95% confidence interval with a random-effects model were assessed. RESULTS: Eight studies were included in this study, including 2 studies with a low risk of bias, 4 studies having ‘some concerns’, and 2 studies with high risk of bias. Significant difference was not found in the risk of SSI for patients with staples (n = 557) versus sutures (n = 573) (RR: 1.70, 95% CI: 0.94–3.08, I(2) = 16%). The results were similar after excluding the studies with a high risk of bias (RR: 1.67, 95% CI: 0.91–3.07, I(2) = 32%). Analysis of studies with low risk of bias revealed a significantly higher risk of surgical site infection in patients with staples (n = 331) compared to sutures (n = 331) (RR: 2.56, 95% CI: 1.20–5.44, I(2) = 0%). There was no difference between continuous and interrupted sutures (P > 0.05). In hip arthroplasty, stapling carried a significantly higher risk of surgical site infection than suturing (RR: 2.51, 95% CI: 1.15–5.50, I(2) = 0%), but there was no significant difference in knee arthroplasty (RR: 0.87, 95% CI: 0.33–2.25, I(2) = 22%; P > 0.05). CONCLUSIONS: Stapling might carry a higher risk of surgical site infection than suturing in elective knee and hip arthroplasties, especially in hip arthroplasty. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s42836-021-00110-7

Diagnostic work-up of suspected scaphoid fractures

The diagnostic work-up of patients with (suspected) scaphoid fractures is flawed by “underdiagnosis” and “over-treatment”. We are unable to identify all scaphoid fractures during patients’ initial visit in Emergency Department, if we continue to rely on painful anatomic snuffbox on clinical examination and plain radiographs as the mainstay of diagnostic imaging. To assure that we do not miss – “underdiagnose” – any scaphoid fractures and do not unnecessarily “over”-treat patients, we have to improve our diagnostic protocol from both clinical- as well as imaging perspectives. The overall aim of this PhD Thesis was to assess current management and to improve both clinical and diagnostic strategies, in order to create a new and more efficient protocol that leads to earlier and more accurate diagnosis, reduces overtreatment, follow-up imaging and outpatient clinic visits without an increased risk of missing a fracture

Outcome Mapping as a monitoring and evaluation tool in the Ecohealth Field Building Initiative Leadership Initiative (FBLI) in Southeast Asia

Monitoring and Evaluation (M&E) activity is essential in any project management and helps to verify if a project has met the planned activities, outputs and outcomes. We present here M&E framework for the Ecohealth Field Building Initiative Leadership Initiative (FBLI) in South East Asia using Outcome Harvesting as a tool. Outcome Harvesting as a variation of Outcome Mapping - a M&E concept focusing on one specific type of result: outcomes as behavioral change - has been used to monitor and evaluate the achievements of hundreds of networks, non-governmental organizations, research centers, think tanks, and community-based organizations around the world. We will describe the process of monitoring used in the FBLI program i.e. how proposed tools such as detailed monitoring and the quarterly bulletin, the self-reflection tool, as well as Outcome Harvesting are integrated to monitor and evaluate the expected outputs as well as what the program’s varying hopes and expectations are, laid out in the project proposal as what the program would love to see, like to see and expect to see in the field of Ecohealth building in South East Asia. The five year FBLI program, funded by the IDRC, is a research project aimed at positing Ecohealth as a sustainable dynamic field in the region. The three major components of the project, namely capacity building, knowledge translation, and research, are the progress markers that can be considered as indicators of behavioral change in boundary partners as well as desired outcomes in the Ecohealth field. These provide a basis for monitoring the progress and outcomes of the program