33 research outputs found

    All-arthroscopic versus mini-open repair of small or moderate-sized rotator cuff tears: A protocol for a randomized trial [NCT00128076]

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    BACKGROUND: Rotator cuff tears are the most common source of shoulder pain and disability. Only poor quality studies have compared mini-open to arthroscopic repair, leaving surgeons with inadequate evidence to support optimal, minimally-invasive repair. METHODS/DESIGN: This randomized, multi-centre, national trial will determine whether an arthroscopic or mini-open repair provides better quality of life for patients with small or moderate-sized rotator cuff tears. A national consensus meeting of investigators in the Joint Orthopaedic Initiative for National Trials of the Shoulder (JOINTS Canada) identified this question as the top priority for shoulder surgeons across Canada. The primary outcome measure is a valid quality-of-life scale (Western Ontario Rotator Cuff (WORC)) that addresses 5 domains of health affected by rotator cuff disease. Secondary outcomes will assess rotator cuff functionality (ROM, strength, Constant score), secondary dimensions of health (general health status (SF-12) and work limitations), and repair integrity (MRI). Outcomes are measured at baseline, at 6 weeks, 3, 6, 12, and 24 months post-operatively by blinded research assistants and musculoskeletal radiologists. Patients (n = 250) with small or medium-sized cuff tears identified by clinical examination and MRI who meet eligibility criteria will be recruited. This sample size will provide 80% power to statistically detect a clinically important difference of 20% in WORC scores between procedures after controlling for baseline WORC score (α = 0.05). A central methods centre will manage randomization, data management, and monitoring under supervision of experienced epidemiologists. Surgeons will participate in either conventional or expertise-based designs according to defined criteria to avoid biases from differential surgeon expertise. Mini-open or all-arthroscopic repair procedures will be performed according to a standardized protocol. Central Adjudication (of cases), Trial Oversight and Safety Committees will monitor trial conduct. We will use an analysis of covariance (ANCOVA), where the baseline WORC score is used as a covariate, to compare the quality of life (WORC score) at 2 years post-operatively. As a secondary analysis, we will conduct the same statistical test but will include age and tear size as covariates with the baseline score. Enrollment will require 2 years and follow-up an additional 2 years. The trial will commence when funding is in place. DISCUSSION: These results will have immediate impact on the practice behaviors of practicing surgeons and surgical trainees at JOINTS centres across Canada. JOINTS Canada is actively engaged in knowledge exchange and will publish and present findings internationally to facilitate wider application. This trial will establish definitive evidence on this question at an international level

    Ulnar-sided wrist pain. II. Clinical imaging and treatment

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    Pain at the ulnar aspect of the wrist is a diagnostic challenge for hand surgeons and radiologists due to the small and complex anatomical structures involved. In this article, imaging modalities including radiography, arthrography, ultrasound (US), computed tomography (CT), CT arthrography, magnetic resonance (MR) imaging, and MR arthrography are compared with regard to differential diagnosis. Clinical imaging findings are reviewed for a more comprehensive understanding of this disorder. Treatments for the common diseases that cause the ulnar-sided wrist pain including extensor carpi ulnaris (ECU) tendonitis, flexor carpi ulnaris (FCU) tendonitis, pisotriquetral arthritis, triangular fibrocartilage complex (TFCC) lesions, ulnar impaction, lunotriquetral (LT) instability, and distal radioulnar joint (DRUJ) instability are reviewed

    The relationship between spatial transformations and iconic gestures

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    Current theories of gesture production all suggest that spatial working memory is a critical component of iconic gesture production. However, none of the models has a selection mechanism for what aspect of spatial working memory is gestured. We explored how expert and journeyman scientists gestured while discussing their work. Participants were most likely to make iconic gestures about change over time (spatial transformations), less likely to gesture about spatial relations and locations (geometric relations), and far less likely to gesture about the magnitude of spatial entities. We also found that experts were especially likely to have a high degree of association between iconic gestures and spatial transformations. These results show that different features of spatial language are gestured about at different rates. We suggest that current gesture production models need to be expanded to include selection mechanisms to account for these differences. © 2006, Lawrence Erlbaum Associates, Inc

    Curricular Progress Assessments: The MileMarker

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    Investigating temporal implications of information transition in submarine command teams

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    Previous work revealed bottlenecks in information transition between submarine command team members, which may be detrimental to overall performance. To date, the potential impact of such bottlenecks in terms of time to pass critical information has not been investigated. An understanding of the temporal impact is critical, given the time critical nature of tactical picture generation. Four teams of eight participants (32 participants total) were recruited and trained at one of the operator stations in a bespoke built submarine control room simulator. Participants completed high and low demand Return to Periscope Depth scenarios. The timings of technology-human and human-human interactions were calculated. Preliminary results indicated that the largest temporal lag was the transition of human-human information. Furthermore, loss of information occurred with every stage of information transition. As demand increased, the efficiency of information transition was negatively impacted by increased communications between operators. Initial results are discussed along with future analysis plans.</p
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