Generating evidence and understanding the treatment of osteoarthritis in Brazil: a study through Delphi methodology

OBJECTIVES: This study aimed to provide evidence for understanding how to treat osteoarthritis (OA) in our country. Therefore, it was necessary to match information and investigations related to the treatment of the disease from the three main types of specialists involved: physiatrists, orthopedists and rheumatologists. METHODS: The authors acted as a scientific advisory committee. From the initial discussions, a structured questionnaire was developed for use with a group of specialists on OA using the Delphi technique. The questionnaire was sent to 21 experts appointed by the authors, and the results obtained were critically analyzed and validated. RESULTS: The prevalence of OA was 33% in Brazil, corresponding to one-third of the individuals in the reference population, which included individuals over 25 years of age. Another significant finding was that most patients did not receive any form of treatment in the early stages of OA. CONCLUSION: The committee pointed to the need for early intervention and that the available medicinal resources can fulfil this important role, as is the case with SYSADOA treatments. Glucosamine-based medicinal products with or without chondroitin could also fulfill this need for early treatment. The other generated evidence and included investigations were then grouped together and are the subject of this publication.

Índice autorreferido pela equipe de cirurgia ortopédica sobre as recomendações e diretrizes internacionais e nacionais para a prevenção de infecção do sítio cirúrgico

As Infecções de Sítio Cirúrgico (ISC) estão entre as mais importantes, associadas à assistência em saúde, compreendendo cerca 31% daquelas encontradas em pacientes hospitalizados. Quando ocorrem, aumentam os custos com tratamento, tempo de internação e os riscos de morbimortalidade dos pacientes. Mesmo com as recomendações para sua prevenção, as taxas de infecção continuam alarmantes e podem estar relacionadas a não adesão às diretrizes publicadas nos guidelines. Objetivou-se avaliar índice autorreferido pela equipe de cirurgia ortopédica sobre as recomendações e diretrizes internacionais e nacionais para a prevenção de infecção do sítio cirúrgico. Tratou-se de um estudo descritivo realizado em Centros Cirúrgicos (CC) de dois hospitais situados no município de Belo Horizonte, Minas Gerais. Os dados foram analisados no programa Stata, versão 14, por meio de análise descritiva. Este trabalho aprovado pelo Comitê de Ética em Pesquisa da Universidade Federal de Minas Gerais (CAAE: 53645715.0.0000.5149). Foram elegíveis para este estudo 133 profissionais sendo 30 (22,5%) cirurgiões ortopedistas; 10 (7,5%) enfermeiros e 93 (69,9%) técnicos de enfermagem. Observou-se predomínio de mulheres 61,3%; idade > 35 anos, (53,4%); casados 55,6%, com tempo de atuação profissional > 8 anos, (58,6%). As referencias às medidas de prevenção da ISC foi de 39,8% para equipe médica e 35,4% para enfermagem. No tocante ao protocolo de cirurgia segura, a média foi de 25,9% para equipe médica e 30,9% para enfermagem. Observou-se semelhança quanto ao grau de importância atribuído pelas duas equipes a cada medida de prevenção. O menor índice autorreferido se destacou em medidas como indicação da descontaminação nasal em pacientes portadores de MMR, 10,7% pela equipe médica; indicação do banho pré-operatório 6,6% pelos médicos e 7,8% da enfermagem. No transoperatório, apenas 10,0% e 3,0% das respectivas equipes referiram ao tempo correto da troca de luvas...

Surgical Site Infections (SSI) are amidst the most important, associated with health care, comprising about 31% of those found in hospitalized patients. When occur, they increase the treatment costs, time of hospitalization, and the risks of patients’ morbimortality. Even with recommendations for their prevention, infection rates remain alarming and it may be related to non-adherence to the published guidelines. The objective was to evaluate the self-reported index by the orthopedic surgery team on international and national recommendations and guidelines for the prevention of surgical site infection. This was a descriptive study performed on Surgical Centers (SC) from two hospitals located in the city of Belo Horizonte, Minas Gerais. Data were analyzed in the Stata program, version 14, through descriptive analysis. This work was approved by the Research Ethics Committee of the Universidade Federal de Minas Gerais (CAAE: 53645715.0.0000.5149). A total of 133 professionals were eligible, wherof 30 (22.5%) were orthopedic surgeons, 10 (7.5%) nurses and 93 (69.9%) nursing technicians. It was observed a predominance of women, 61.3%; age> 35 years (53.4%); married 55.6%, with work time> 8 years, (58.6%). The references to preventive measures of SSI were 39.8% for medical staff and 35.4% for nursing staff. Regarding the protocol of safe surgery, the average was 25.9% for the medical staff and 30.9% for the nursing staff. A similarity was observed regarding the degree of importance attributed by the two teams to each prevention measure. The lowest self-reported index was highlighted in measures such as indication of nasal decontamination in patients with MMR, 10.7% by the medical staff; indication of preoperative bath, 6.6% by physicians and 7.8% by nursing staff. In the transoperative period, only 10.0% and 3.0% of the respective teams referred to the correct time of glove exchange...

Análise das propriedades psicométricas do American Orthopaedic Foot and Ankle Society Score (Aofas) em pacientes com artrite reumatoide: aplicação do modelo Rasch / Analysis of the psychometric properties of the American Orthopaedic Foot and Ankle Society Score (AOFAS) in rheumatoid arthritis patients: application of the Rasch model

Resumo Objetivo: Testar a confiabilidade e a validade do escore Aofas em uma amostra de pacientes com artrite reumatoide. Métodos: A escala foi aplicada a pacientes com artrite reumatoide, duas vezes pelo entrevistador 1 e uma vez pelo entrevistador 2. O Aofas foi submetido a exame de confiabilidade teste-reteste (com 20 indivíduos com artrite reumatoide). As propriedades psicométricas foram investigadas pela análise Rasch em 33 pacientes com artrite reumatoide. Resultados: O coeficiente de correlação intraclasse (CCI) foi de 0,90 < CCI < 0,95 (p < 0,001) para a confiabilidade intraexaminador e 0,75 < CCI < 0,91 (p < 0,001) para a confiabilidade interexaminador. O índice de separação dos indivíduos foi de 1,9 e 4,75 para os itens. Isso demonstra que os pacientes se dividiam em três níveis de habilidade e os itens foram divididos em seis níveis de dificuldades. A análise Rasch mostrou que oito itens foram satisfatórios. Foi identificado um item errôneo, que mostrou percentuais acima dos 5% permitidos pelo modelo estatístico. Além disso, o modelo Rasch sugeriu a revisão do item 8 original. Conclusões: Os resultados sugerem que a versão brasileira do Aofas apresenta confiabilidade adequada, validade de constructo e estabilidade de resposta. Esses resultados indicam que a escala de tornozelo-retropé Aofas apresenta um potencial significativo de aplicabilidade clínica em indivíduos com artrite reumatoide. Outros estudos em populações com outras características já estão em andamento.

Abstract Objective: To tested the reliability and validity of Aofas in a sample of rheumatoid arthritis patients. Methods: The scale was applicable to rheumatoid arthritis patients, twice by the interviewer 1 and once by the interviewer 2. The Aofas was subjected to test-retest reliability analysis (with 20 Rheumatoid arthritis subjects). The psychometric properties were investigated using Rasch analysis on 33 Rheumatoid arthritis patients. Results: Intra-Class Correlation Coefficient (ICC) were (0.90 < ICC < 0.95; p < 0.001) for intra-observer reliability and (0.75 < ICC < 0.91; p < 0.001) for inter-observer reliability. Subjects separation rates were 1.9 and 4.75 for the items, showing that patients fell into three ability levels, and the items were divided into six difficulties levels. The Rasch analysis showed that eight items was satisfactory. One erroneous item have been identified, showing percentages above the 5% allowed by the statistical model. Further Rasch modeling suggested revising the original item 8. Conclusions: The results suggest that the Brazilian versions of Aofas exhibit adequate reliability, construct validity, response stability. These findings indicate that Aofas Ankle-Hindfoot scale presents a significant potential for clinical applicability in individuals with rheumatoid arthritis. Other studies in populations with other characteristics are now underway.

Protocolos de encaminhamento da atenção básica para a atenção especializada: reumatologia e ortopedia / Primary care referral protocols for specialized care: rheumatology and orthopedics

Este material tem como objetivo orientar as equipes que atuam na AB, qualificando o processo de referenciamento de usuários para outros serviços especializados. É uma ferramenta, ao mesmo tempo, de gestão e de cuidado, pois tanto guiam as decisões dos profissionais solicitantes quanto se constitui como referência que modula as avaliações apresentadas pelos médicos reguladores.

Fracturas diafiarias de los miembros inferiores: planificación preoperatoria digital / Diaphyseal fractures of the lower limbs: digital preoperative planning

La planificación preoperatoria es procedimiento indispensable previo a la realización de cualquier cirugía ortopédica con el fin de obtener un resultado exitoso, sin embargo, el proceso suele ser lento y engorroso, por lo que pocos cirujanos ortopedistas lo realizan de manera rutinaria. Planteamos el desarrollo de un Software de planificación preoperatoria digital para fracturas diafisiarias de miembros inferiores que pueda ser utilizado como una herramienta confiable en la práctica diaria del cirujano ortopedista. Mediante la obtención de un archivo de imagen con la fractura que se desea planificar, a través de una cámara digital o de un sistema PACS integrado, nuestro software permitirá la realización de una planificación preoperatoria de manera precisa y rápida brindándole al usuario herramientas de registros y almacenamiento de datos, calibración y mejoramiento de imagen, medición de distancias y ángulos, segmentación del trazo de fracturas, etc. También se incluyen galería implantes ortopédicos, así como sistema de clasificación AO, todo lo anterior con el fin de generar de un reporte que incluya todos los detalles necesarios que puedan facilitar la labor del ortopedista previo al momento del acto quirúrgico

Preoperative planning is a cornerstone procedure prior any orthopaedic surgery in terms of achieving excellent results, however, the process is slow and difficult; hence,there are few orthopaedic surgeons who perform it on a day-to-day basis. We Propose the Development of a Preoperative Planning Software for the lower limbs long bone diaphiseal fractures that can serve as reliabletool for the orthopaedic surgeon. Using an image archive with the fracture site, obtained from a digital camera or a PACS integrated system, our software can perform a preoperative planning in a fast and precise manner, giving the user tools to perform data managementand storing, image calibration and rendering, distance measuring and angle calculation, fracture site segmentation, etc. Also includes a diverse orthopaedic implants gallery, and the AO comprehensive classificationsystem; all of the above made it with the final goal to generate a report who includes all the necessary details,to facilitate the surgeon duty, prior to the surgery per se.

Orthopaedic Patients' satisfaction in outpatient experience of A University Hospital

The orthopaedic surgery department was formed in 1982 at College of Medicine, King Faisal University and King Fahd University Hospital, Al-Khobar. At present there are four adult orthopaedic clinics and two pediatric orthopaedic clinics with an annual number of over 9000 patients. Offering services is one thing and providing satisfaction is another. To date no patient satisfaction survey was conducted for orthoapedic patients at our hospital. This prospective survey was conducted to assess the satisfaction of adult orthopaedic patients with regard to care offered at King Fahd University Hospital, Al-Khobar., to identify existing shortfalls and to find ways to improve them. Four hundred adult orthopaedic patients were interviewed by a predetermined questionnaire. Patients were randomly selected, from each clinic and the satisfaction was graded as poor, fair, good, and excellent. Once the questionnaire was completed, patients were asked a final question for and overall satisfaction on a two-point scale of [satisfied and unsatisfied]. The questionnaire assessed appointments, courtesy, professional aspects, registration, Nurses and Doctors. Four hundred patients completed the questionnaire. The average age of patients was 48.4 years [14-92 SD +/- +/- 35.1]. Saudi nationals comprised 67% and non-Saudis were 33%. On a four-point scale excellent and good was taken as satisfied and a total of 92.3% were satisfied but this dropped to 85.5% on a two-point scale. Patients who were educated [graduate level] their satisfaction level was higher than those of the uneducated P<.001. Seventy-five percent of the patients were dissatisfied with the delay in appointments P <0.001 and 304 patients were not satisfied due to the time they spent in the hospital P<0.001 This survey indicates that most patients attending orthopaedic clinics at King Fahd University Hospital, Al-Khobar were satisfied with the care they were offered but dissatisfied by the delay in obtaining the appointments, and the time they spent in the hospital. The authors recommend measures to improve services so that more orthopaedic patients will be satisfied

Epicondilitis y epitrocleitis: resultados del tratamiento quirúrgico

El tratamiento médico proporciona muy buenos resultados en el manejo de la epicondilitis y la epitrocleitis. El tratamiento quirúrgico debe tenerse como alternativa para los casos refractarios. Nuestra indicación para cirugía es persistencia de los síntomas luego de un mínimo de seis meses de tratamiento médico. En este trabajo presentamos nuestra experiencia en 15 pacientes, con un seguimiento promedio de 24 meses (mínimo 6 meses) con una técnica quirúrgica anatoómica, que respeta las inserciones tendinosas que no están afectadas, reseca la hiperplasia angiofibroblástica-cuando ésta es visible- en la inserción del extensor carpi radialis brevis (para la epicondilitis) y en la del pronator teres o el flexor carpi ulnaris (en el caso de la epitrocleitis), e incluye curetaje y perforaciones epicondíleas o epitrocleares

Normas para atendimento aos hemofílicos e portadores de coagulopatias congênitas / Rules for attending patients with hemophilia and congenital blood coagulation disorders

O objetivo primordial do trabalho foi dar as linhas gerais de diagnóstico e conduta frente às diversas intercorrências médicas, odontológicas, psico-sociais e fisioterápicas...

Antibioticos Profilácticos en Cirugia Ortopédica

Una de las mayores complicaciones que puede enfrentar un Ortopedista es la infección, siendo esta una causa de morbilidad importante en la especialidad. Con el incremento del trauma, de los procedimientos para cirugías reconstructivas y de columna, los riesgos de infección quirúrgica han aumentado. Espor esto que el cirujano ortopedista actual, debe estar familiarizado con el uso adecuado de los antibióticos. Este artículo pretende hacer una versión sobre la situación actual de la antibioticoterapia profiláctica en ortopedia, sus indicaciones, beneficios y controversias

La rehabilitacion precoz en traumatologia / Early rehabilitation in traumatology

Revisados los libros de de tres servicios quirurgicos de nuestro Hospital de Clinicas Universitario, se establece que en los ultimos 5 anos, el numero de pacientes a los que se prescribio rehabilitacion precoz fue pequeno. La rehabilitacion precoz, no solamente en los casos qeu se mencionana, sino en todos los casos mas generalizados, tambien significara una disminucion considerable del tiempo de internacion en Hospitales, y un pronto y mejor retorno a la vida familiar.