A hierarquia das evidências em cirurgia da mão nas revistas ortopédicas nacionais

CONTEXT AND OBJECTIVE: There is no systematic assessment of the quality of scientific production in the specialty of hand surgery in our setting. This study aimed to systematically assess the status of evidence generation relating to hand surgery and to evaluate the reproducibility of the classification method based on an evidence pyramid. DESIGN AND SETTING: Secondary study conducted at Universidade Federal de São Paulo (UNIFESP) and Faculdade Estadual de Medicina de Marília (Famema). METHODS: Two researchers independently conducted an electronic database search for hand surgery studies published between 2000 and 2009 in the two main Brazilian orthopedic journals (Acta Ortopédica Brasileira and Revista Brasileira de Ortopedia). The studies identified were subsequently classified according to methodological design (systematic review of the literature, randomized clinical trial, cohort study, case-control study, case series and other studies) and evidence level (I to V). RESULTS: A total of 1,150 articles were evaluated, and 83 (7.2%) were included in the final analysis. Studies with evidence level IV (case series) accounted for 41 (49%) of the published papers. Studies with evidence level V (other studies) accounted for 12 (14.5%) of the papers. Only two studies (2.4%) were ranked as level I or II. The inter-rater reproducibility was excellent (k = 0.94). CONCLUSIONS: Hand surgery articles corresponded to less than one tenth of Brazilian orthopedic production. Studies with evidence level IV were the commonest type. The reproducibility of the classification stratified by evidence level was almost perfect.CONTEXTO E OBJETIVO: Não há uma avaliação sistemática da qualidade da produção científica na especialidade de cirurgia da mão em nosso meio. Este estudo objetiva analisar o status da geração de evidências em cirurgia da mão, por meio de avaliação sistematizada, além de avaliar a reprodutibilidade da classificação baseada na pirâmide das evidências. TIPO DE ESTUDO E LOCAL: Estudo secundário realizado pela Universidade Federal de São Paulo (UNIFESP) e Faculdade Estadual de Medicina de Marília (Famema). MÉTODOS: De forma independente, dois pesquisadores promoveram uma busca eletrônica dos trabalhos envolvendo cirurgia da mão, no período de 2000-2009, para duas principais revistas na literatura ortopédica nacional (Acta Ortopédica Brasileira e Revista Brasileira de Ortopedia). Os trabalhos identificados foram subsequentemente classificados pelo tipo de delineamento metodológico (revisões sistemáticas da literatura, estudos clínicos randomizados, estudos de coorte, estudos caso-controle, séries de casos e outros estudos) e nível de evidência (I a V). RESULTADOS: Foram avaliados 1.150 artigos, sendo 83 (7,2%) considerados para a análise final. Estudos com nível de evidência IV (séries de caso) correspondem a 41 (49%) das publicações. Estudos nível de evidência V (outros estudos), corresponderam a 12 (14,5%) da amostra. Apenas dois estudos (2,4%) foram identificados como nível I ou II. A reprodutibilidade interobservadores foi excelente (k = 0.94). CONCLUSÕES: Os artigos de cirurgia da mão correspondem a menos de um décimo da produção ortopédica nacional. Estudos nível de evidência IV foram os mais encontrados na literatura nacional. A classificação estratificada por níveis de evidência apresenta reprodutibilidade quase perfeita.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUniversidade Federal de São Paulo (UNIFESP) Department of Orthopedics and TraumatologyFaculdade Estadual de Medicina de MaríliaFaculdade Estadual de Medicina de Marília Department of Orthopedics and TraumatologyUniversidade Federal de São Paulo (UNIFESP)UNIFESP, EPMUNIFESP, Department of Orthopedics and TraumatologyUNIFESPSciEL

Exposure of the surgical team to ionizing radiation during orthopedic surgical procedures,

OBJECTIVE: the aim of this study was to assess the degree of exposure of the orthopedic surgical team to fluoroscopic ionizing radiation.METHODS: the ionizing radiation to which the orthopedic surgical team (R1, R2 and R3) was exposed was assayed using thermoluminescent dosimeters that were distributed in target anatomical regions (regions with and without protection using a lead apron). This was done during 45 hip osteosynthesis procedures to treat transtrochanteric fractures that were classified as 31-A2.1 (AO).RESULTS: the radioactive dose received by R3 was 6.33 mSv, R2 4.51 mSv and R3 1.99 mSv (p = 0.33). The thyroid region received 0.86 mSv of radiation, the thoracic region 1.24 mSv and the gonadal region 2.15 mSv (p = 0.25). There was no record of radiation at the dosimeters located below the biosafety protectors or on the team members' backs.CONCLUSIONS: the members of the surgical team who were located closest to the fluoroscope received greater radiation doses than those located further away. The anatomical regions located below the waistline were the ones that received most ionizing radiation. These results emphasize the importance of using biosafety devices, since these are effective in preventing radiation from reaching the vital organs of the medical team

Hierarchy of evidence relating to hand surgery in Brazilian orthopedic journals

CONTEXT AND OBJECTIVE: There is no systematic assessment of the quality of scientific production in the specialty of hand surgery in our setting. This study aimed to systematically assess the status of evidence generation relating to hand surgery and to evaluate the reproducibility of the classification method based on an evidence pyramid. DESIGN AND SETTING: Secondary study conducted at Universidade Federal de São Paulo (Unifesp) and Faculdade Estadual de Medicina de Marília (Famema). METHODS: Two researchers independently conducted an electronic database search for hand surgery studies published between 2000 and 2009 in the two main Brazilian orthopedic journals (Acta Ortopédica Brasileira and Revista Brasileira de Ortopedia). The studies identified were subsequently classified according to methodological design (systematic review of the literature, randomized clinical trial, cohort study, case-control study, case series and other studies) and evidence level (I to V). RESULTS: A total of 1,150 articles were evaluated, and 83 (7.2%) were included in the final analysis. Studies with evidence level IV (case series) accounted for 41 (49%) of the published papers. Studies with evidence level V (other studies) accounted for 12 (14.5%) of the papers. Only two studies (2.4%) were ranked as level I or II. The inter-rater reproducibility was excellent (k = 0.94). CONCLUSIONS: Hand surgery articles corresponded to less than one tenth of Brazilian orthopedic production. Studies with evidence level IV were the commonest type. The reproducibility of the classification stratified by evidence level was almost perfect