A locally adapted functional outcome measurement score for total hip replacement in west Africa: introduction of the Ouaga score

Background: Functional outcome scores are often used to measure results of Total Hip Replacement (THR). Most current scoring systems were designed for use in Europe or North America and seem not optimally suited for a general West African setting. We introduce a cross-cultural adaptation of the Lequesne index as a new score.Method: A new functional hip score, adapted to the West African setting and based on the Lequesne Index was introduced. To evaluate this score, the score questionnaire was completed by a group of patients in the Paul VI Hospital in Ouagadougou, Burkina Faso, who were possible candidates for hip replacement. Patients with hip fractures were excluded. Double scores acquired with a minimal interval of four weeks were analysed and test-retest reliability was assessed using intra-class correlation coefficient.Results: Mean patient age was 43,3 years. All patients were able to answer all questions. Double scores were available in 21 patients. Intra-class correlation coefficient was 0.896 indicating very good correlation.Conclusion: The current study has shown that the cross-cultural adaptation of the Lequesne Index, used as Ouaga Score. It can be obtained easily and is reliable in a general West African patient population. We recommend the use of the Ouaga Score for functional evaluation and follow-up of THR in West Africa.Keywords: THR, Hip, Africa, Functional score, Hip replacement, Arthroscop

Effect of pain induction and pain reduction on conditioned pain modulation: a systematic review

Pain facilitation as well as pain inhibition might be present in chronic pain patients. A decreased efficacy of pain inhibition can be measured by conditioned pain modulation (CPM). The use of the CPM paradigm in scientific research has boosted over the last few years and is recognized for its high clinical relevance in chronic pain patients. It is however unclear whether the presence of pain and possible modulations of pain influences the efficacy of endogenous pain inhibition, measured by CPM. This systematic literature study aimed to provide an overview of the effects of clinical pain and experimental pain induction or pain reduction on CPM in adults. A systematic literature search was conducted in the databases “Pubmed” and “Web of Science”. Only full texts of original studies regarding the effect of clinical pain and experimentally induced pain and pain reduction on CPM in adults were included. The included articles were scored on methodological quality and through a CPM-paradigm. Twelve articles of good to moderate quality were included in this review. Some pain inhibitory medication and oral contraceptives inhibit the CPM mechanism. Removing chronic pain by surgery results in an improved CPM response. This effect is not observed when removing acute pain. Analgesic medication and oral contraceptives might inhibit the CPM response whereas there is limited evidence that pain relieving surgery improves CPM in chronic pain patients. However the results merely suggest that decreased CPM values (as in chronic pain patients) can improve after elimination of pain

Isolated radial head dislocation, a rare and easily missed injury in the presence of major distracting injuries: a case report

High velocity accidents can lead to major injuries – long bone fractures, abdominal trauma, pelvic fractures and chest injuries. These injuries can act as distracting factors during the initial assessment of a polytrauma patient and innocuous but significant smaller injuries can be missed. We present a rare case of isolated anterolateral radial head dislocation in a polytrauma patient

Risk Factors For Recurrent Stroke After Coronary Artery Bypass Grafting

<p>Abstract</p> <p>Objectives</p> <p>Preventing stroke after coronary artery bypass grafting (CABG) remains a therapeutic goal, due in part to the lack of identifiable risk factors. The aim of this study, accordingly, was to identify risk factors in CABG patients with a previous history of stroke.</p> <p>Methods</p> <p>Patients with a history of stroke who underwent CABG at Beijing An Zhen hospital from January 2007 to July 2010 were selected (n = 430), and divided into two groups according to the occurrence of postoperative stroke. Pre-operative and post-operative data were retrospectively collected and analyzed by univariate and multivariate logistic regression analyses.</p> <p>Results</p> <p>Thirty-two patients (7.4%) suffered post-operative stroke. Univariate analysis identified several statistically significant risk factors in the post-operative stroke group, including pre-surgical left ventricular ejection fractions (LVEF) ≤50%, on-pump surgery, post-operative atrial fibrillation (AF), and hypotension. Multivariable analysis identified 4 independent risk factors for recurrent stroke: unstable angina (odds ratio (OR) = 2.95, 95% CI: 1.05-8.28), LVEF ≤50% (OR = 2.77, 95% CI: 1.23-6.27), AF (OR = 4.69, 95% CI: 1.89-11.63), and hypotension (OR = 2.55, 95% CI: 1.07-6.04).</p> <p>Conclusion</p> <p>Unstable angina, LVEF ≤50%, post-operative AF, and post-operative hypotension are independent risk factors of recurrent stroke in CABG patients with a previous history of stroke.</p

Considering chance in quality and safety performance measures: an analysis of performance reports by boards in English NHS trusts

Objectives Hospital board members are asked to consider large amounts of quality and safety data with a duty to act on signals of poor performance. However, in order to do so it is necessary to distinguish signals from noise (chance). This article investigates whether data in English National Health Service (NHS) acute care hospital board papers are presented in a way that helps board members consider the role of chance in their decisions. Methods Thirty English NHS trusts were selected at random and their board papers retrieved. Charts depicting quality and safety were identified. Categorical discriminations were then performed to document the methods used to present quality and safety data in board papers, with particular attention given to whether and how the charts depicted the role of chance, that is, by including control lines or error bars. Results Thirty board papers, containing a total of 1488 charts, were sampled. Only 88 (6%) of these charts depicted the role of chance, and only 17 of the 30 board papers included any charts depicting the role of chance. Of the 88 charts that attempted to represent the role of chance, 16 included error bars and 72 included control lines. Only 6 (8%) of the 72 control charts indicated where the control lines had been set (eg, 2 vs 3 SDs). Conclusions Hospital board members are expected to consider large amounts of information. Control charts can help board members distinguish signals from noise, but often boards are not using them. We discuss demand-side and supply-side barriers that could be overcome to increase use of control charts in healthcare