One year outcome of surgery versus cast immobilisation for adults with an acute undisplaced or minimally displaced scaphoid fracture-A meta-analysis of randomised controlled trials

Aims There has been an increasing trend for early fixation of scaphoid fractures despite uncertain evidence. We conducted a meta-analysis to evaluate up-to date evidence from randomised controlled trials (RCTs) comparing the effectiveness of non-operative and surgical treatment for acute undisplaced and minimally displaced scaphoid fractures (≤2mm displacement). Methods A systematic review of seven databases was performed from inception until the end of March 2021 to identify eligible RCTs. Reference lists of included studies were screened. No language restrictions were applied. The primary outcome was patient reported outcome measure of wrist function at 12 months. Meta-analysis was performed for function, pain, range of motion, grip strength and union. Complications are reported narratively. Results Seven RCTs were included. There was no difference in function at 12 months (Hedges’ g 0.15, 95% CI -0.02 to 0.32, p=0.08). Complication rate was higher in the operative group with more serious complications. Conclusions We found no difference in functional outcome at 12 months for scaphoid waist fractures (≤2mm displacement) treated with a cast or surgical fixation. Complication rate is higher with surgical fixation

Implementing practice guidelines: A workshop on guidelines dissemination and implementation with a focus on asthma and COPD

The present supplement summarizes the proceedings of the symposium “Implementing practice guidelines: A workshop on guidelines dissemination and implementation with a focus on asthma and COPD”, which took place in Quebec City, Quebec, from April 14 to 16, 2005. This international symposium was a joint initiative of the Laval University Office of Continuing Medical Education (Bureau de la Formation Médicale Continue), the Canadian Thoracic Society and the Canadian Network for Asthma Care, and was supported by many other organizations and by industrial partners. The objectives of this meeting were to examine the optimal implementation of practice guidelines, review current initiatives for the implementation of asthma and chronic obstructive pulmonary disease (COPD) guidelines in Canada and in the rest of the world, and develop an optimal strategy for future guideline implementation. An impressive group of scientists, physicians and other health care providers, as well as policy makers and representatives of patients’ associations, the pharmaceutical industry, research and health networks, and communications specialists, conveyed their perspectives on how to achieve these goals