Validation of a second-generation appropriateness classification system for total knee arthroplasty: a prospective cohort study.

BACKGROUND: To test the validity of a second-generation appropriateness system in a cohort of patients undergoing total knee arthroplasty (TKA). METHODS: We applied the RAND/UCLA Appropriateness Method to derive our second-generation system and conducted a prospective study of patients diagnosed with knee osteoarthritis in eight public hospitals in Spain. Main outcome questionnaires were the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Short-Form-12 (SF-12), and the Knee Society Score satisfaction scale (KSS), completed before and 6 months after TKA. Baseline, changes from baseline to 6 months (journey outcome), and 6-month scores (destination outcome) were compared according to appropriateness category. Percentage of patients attaining the minimal clinically important difference (MCID) and responders according to Outcome Measures in Rheumatology-Osteoarthritis Research Society (OMERACT-OARSI) criteria were also reported. RESULTS: A total of 282 patients completed baseline and 6-month questionnaires. Of these, 142 (50.4%) were classified as Appropriate, 90 (31.9%) as Uncertain, and 50 (17.7%) as Inappropriate. Patients classified as Appropriate had worse preoperative pain, function, and satisfaction (p < 0.001) and had greater improvements (i.e., journey scores) than those classified as Inappropriate (p < 0.001). At 6 months, destination scores for pain, function, or satisfaction were not significantly different across appropriateness categories. The percentage of patients meeting responder criteria (p < 0.001) and attaining MCID was statistically higher in Appropriate versus Inappropriate groups in pain (p = 0.04) and function (p = 0.004). CONCLUSIONS: The validity of our second-generation appropriateness system was generally supported. The findings highlight a critical issue in TKA healthcare: whether TKA appropriateness should be driven by the extent of improvement, by patient final state, or by both.

Indicadores de proceso como herramienta para monitorizar la asistencia al paciente con traumatismo grave en Cataluña / Process indicators: tools for monitoring the management of severe trauma cases in Catalonia

Objetivos: Los indicadores de proceso (IP) se han utilizado ampliamente para monitorizar los procesos asistenciales al paciente traumático. Nuestro objetivo es analizar la capacidad de un registro hospitalario de traumatismo grave para evaluar algunos aspectos de la atención inicial al traumatismo grave. Método: Observacional, retrospectivo de datos incluidos en un registro poblacional. A partir de un consenso de expertos se seleccionaron una serie de IP que se aplicaron a una población de accidentados. Los IP seleccionados analizan algunos aspectos de la atención inicial, diagnósticos y terapéuticos. Cuatro de ellos se refieren a la fase prehospitalaria y 5 a la fase hospitalaria. Para todos ellos se calculó la tasa de cumplimiento (observados vs esperados). Resultados: Fueron analizados 1.526 casos (44,4%) correspondientes al año 2013 y 1.908 (55,6%) del 2014. Tres de los cuatro IP relacionados con la atención prehospitalaria pudieron ser analizados: intubación orotraqueal en paciente con puntuación de la Escala del Coma de Glasgow (GCS) mas o igual a 8 (84% de cumplimiento); acceso vascular canalizado antes de la llegada al hospital (83,4% de cumplimiento); y contención cervical aplicada in situ (72,7% de cumplimiento). En la fase hospitalaria: realización de tomografía computarizada (TC) craneal en los primeros 60 min en GCS menor o igual a 13 (5,3% de cumplimiento); craneotomía en paciente candidato en las primeras 2 horas después del diagnóstico (65% de cumplimiento); exploración diagnóstica en traumatismo abdominal en los primeros 60 minutos en pacientes con presión arterial sistólica (PAS) menor o igual a 90 mmHg (89,3% de cumplimiento); y laparotomía o angiografía terapéutica en paciente candidato en las 4 primeras horas tras el trauma abdominal y PAS menor o igual a 90 (51,7% de cumplimiento). El último indicador, cirugía de fractura abierta en las primeras 8 horas tras el accidente, presentó un 69,9% de cumplimiento. Conclusiones: Nuestro estudio muestra las posibilidades y dificultades que un registro de traumatismo en base hospitalaria ofrece para evaluar la asistencia al paciente traumático a través de indicadores de proceso establecidos (AU)

Background and objectives: Process indicators have been widely used to monitor the way trauma care is provided. We aimed to analyze whether data from a hospital’s severe trauma register could facilitate the evaluation of aspects of the initial management of severe injuries. Methods: Observational, retrospective population-based study. A working group of experts selected a set of trauma care process indicators relevant to some aspects of initial care, diagnosis, and treatment of severely injured patients. Four of the indicators referred to prehospital care and 5 to hospital care. We calculated the observed and expected compliance rates for all the indicators. Results: A total of 1526 cases (44.4%) were analyzed for 2013; 1908 (55.6%) were analyzed for 2014. We were able to evaluate 3 of the 4 prehospital process indicators: endotracheal intubation in patients with a score of less than or equal to to 8 on the Glasgow coma scale (GCS) (84% compliance), venous access established before hospital arrival (83.4%), and placement of a neck collar to immobilize the cervical spine (72.7%). Compliance for the hospital-phase indicators were as follows: performance of a computed tomography scan of the head within 60 minutes in cases with a GCS of less than or equal to 13 (5.3% compliance, craniotomy in candidate patients within 2 hours of diagnosis (65%), diagnostic examination for abdominal injuries within 60 minutes in patients with systolic blood pressure less than or equal to 90 mm Hg (89.3%), and therapeutic laparotomy or angiography within 4 hours of abdominal injury in candidate patients with systolic blood pressure less than or equal to 90 mm Hg (51.7%). Compliance was 69.9% for the last process indicator: surgical treatment of open fractures within 8 hours of an accident. Conclusion: Our findings show that a hospital trauma register provides data about care process indicators that can allow us to monitor the quality of care of severely injured patients (AU)

[Process indicators: tools for monitoring the management of severe trauma cases in Catalonia]. / Indicadores de proceso como herramienta para monitorizar la asistencia al paciente con traumatismo grave en Cataluña.

OBJECTIVES: Process indicators have been widely used to monitor the way trauma care is provided. We aimed to analyze whether data from a hospital's severe trauma register could facilitate the evaluation of aspects of the initial management of severe injuries. MATERIAL AND METHODS: Observational, retrospective population-based study. A working group of experts selected a set of trauma care process indicators relevant to some aspects of initial care, diagnosis, and treatment of severely injured patients. Four of the indicators referred to prehospital care and 5 to hospital care. We calculated the observed and expected compliance rates for all the indicators. RESULTS: A total of 1526 cases (44.4%) were analyzed for 2013; 1908 (55.6%) were analyzed for 2014. We were able to evaluate 3 of the 4 prehospital process indicators: endotracheal intubation in patients with a score of 􀀀 8 on the Glasgow coma scale (GCS) (84% compliance), venous access established before hospital arrival (83.4%), and placement of a neck collar to immobilize the cervical spine (72.7%). Compliance for the hospital-phase indicators were as follows: performance of a computed tomography scan of the head within 60 minutes in cases with a GCS of 􀀀 13 (5.3% compliance, craniotomy in candidate patients within 2 hours of diagnosis (65%), diagnostic examination for abdominal injuries within 60 minutes in patients with systolic blood pressure 􀀀 90 mm Hg (89.3%), and therapeutic laparotomy or angiography within 4 hours of abdominal injury in candidate patients with systolic blood pressure 􀀀 90 mm Hg (51.7%). Compliance was 69.9% for the last process indicator: surgical treatment of open fractures within 8 hours of an accident. CONCLUSION: Our findings show that a hospital trauma register provides data about care process indicators that can allow us to monitor the quality of care of severely injured patients.

OBJETIVO: Los indicadores de proceso (IP) se han utilizado ampliamente para monitorizar los procesos asistenciales al paciente traumático. Nuestro objetivo es analizar la capacidad de un registro hospitalario de traumatismo grave para evaluar algunos aspectos de la atención inicial al traumatismo grave. METODO: Observacional, retrospectivo de datos incluidos en un registro poblacional. A partir de un consenso de expertos se seleccionaron una serie de IP que se aplicaron a una población de accidentados. Los IP seleccionados analizan algunos aspectos de la atención inicial, diagnósticos y terapéuticos. Cuatro de ellos se refieren a la fase prehospitalaria y 5 a la fase hospitalaria. Para todos ellos se calculó la tasa de cumplimiento (observados vs esperados). RESULTADOS: Fueron analizados 1.526 casos (44,4%) correspondientes al año 2013 y 1.908 (55,6%) del 2014. Tres de los cuatro IP relacionados con la atención prehospitalaria pudieron ser analizados: intubación orotraqueal en paciente con puntuación de la Escala del Coma de Glasgow (GCS) 8 (84% de cumplimiento); acceso vascular canalizado antes de la llegada al hospital (83,4% de cumplimiento); y contención cervical aplicada in situ (72,7% de cumplimiento). En la fase hospitalaria: realización de tomografía computarizada (TC) craneal en los primeros 60 min en GCS ô€€€ 13 (5,3% de cumplimiento); craneotomía en paciente candidato en las primeras 2 horas después del diagnóstico (65% de cumplimiento); exploración diagnóstica en traumatismo abdominal en los primeros 60 minutos en pacientes con presión arterial sistólica (PAS) 90 mmHg (89,3% de cumplimiento); y laparotomía o angiografía terapéutica en paciente candidato en las 4 primeras horas tras el trauma abdominal y PAS 90 (51,7% de cumplimiento). El último indicador, cirugía de fractura abierta en las primeras 8 horas tras el accidente, presentó un 69,9% de cumplimiento. CONCLUSIONES: Nuestro estudio muestra las posibilidades y dificultades que un registro de traumatismo en base hospitalaria ofrece para evaluar la asistencia al paciente traumático a través de indicadores de proceso establecidos.

International comparative evaluation of knee replacement with fixed or mobile-bearing posterior-stabilized prostheses.

BACKGROUND: Posterior-stabilized total knee prostheses were introduced to address instability secondary to loss of posterior cruciate ligament function, and they have either fixed or mobile bearings. Mobile bearings were developed to improve the function and longevity of total knee prostheses. In this study, the International Consortium of Orthopaedic Registries used a distributed health data network to study a large cohort of posterior-stabilized prostheses to determine if the outcome of a posterior-stabilized total knee prosthesis differs depending on whether it has a fixed or mobile-bearing design. METHODS: Aggregated registry data were collected with a distributed health data network that was developed by the International Consortium of Orthopaedic Registries to reduce barriers to participation (e.g., security, proprietary, legal, and privacy issues) that have the potential to occur with the alternate centralized data warehouse approach. A distributed health data network is a decentralized model that allows secure storage and analysis of data from different registries. Each registry provided data on mobile and fixed-bearing posterior-stabilized prostheses implanted between 2001 and 2010. Only prostheses associated with primary total knee arthroplasties performed for the treatment of osteoarthritis were included. Prostheses with all types of fixation were included except for those with the rarely used reverse hybrid (cementless tibial and cemented femoral components) fixation. The use of patellar resurfacing was reported. The outcome of interest was time to first revision (for any reason). Multivariate meta-analysis was performed with linear mixed models with survival probability as the unit of analysis. RESULTS: This study includes 137,616 posterior-stabilized knee prostheses; 62% were in female patients, and 17.6% had a mobile bearing. The results of the fixed-effects model indicate that in the first year the mobile-bearing posterior-stabilized prostheses had a significantly higher hazard ratio (1.86) than did the fixed-bearing posterior-stabilized prostheses (95% confidence interval, 1.28 to 2.7; p = 0.001). For all other time intervals, the mobile-bearing posterior-stabilized prostheses had higher hazard ratios; however, these differences were not significant. CONCLUSIONS: Mobile-bearing posterior-stabilized prostheses had an increased rate of revision compared with fixed-bearing posterior-stabilized prostheses. This difference was evident in the first year.

Propuesta metodológica: vinculación del programa Farmacología I con la Medicina Natural Tradicional: perfil de Servicios Farmacéuticos / Methodological proposal: linking the syllabus of Pharmacology I with Natural tradicional Medicine: profile of Pharmaceutical Services

Nuestro trabajo aborda la propuesta de incorporación de los conocimientos de la Medicina Natural Tradicional en el programa de Farmacología I que se imparte en la formación completa del perfil de Servicios Farmacéuticos de la Carrera Tecnología de la Salud, con el objetivo de vincular el programa de estudio y sus modalidades, y de esta forma promover la disciplina como una terapia actual y beneficiosa en el mundo moderno, logrando motivar a los profesionales en formación, partiendo de la vinculación de la especialidad (que abarca la Medicina Natural y Tradicional en su estudio) con el farmacéutico, personal paramédico que se encarga de la preparación de los medicamentos fitofármacos y apifármacos. Se impone entonces un sólido conocimiento de las plantas activas, teniendo como principal ventaja la aplicación de estos medicamentos que no implican efectos secundarios en su administración al paciente. Para lo cual incorporamos en cada uno de los temas las modalidades como apifármacos, fitofármacos, acupuntura, ejercicios estimuladores, masajes y otras que comprenden la disciplina, lo que permitirá lograr motivar a los estudiantes en formación a la investigación constante y aplicar los conocimientos adquiridos en la práctica diaria como criterio de la verdad (AU)

This work is about a proposal to incorporate knowledge of Natural and Traditional Medicine in the syllabus of Pharmacology I, a subject that is taught in the profile of Pharmaceutical Services at Health Technology Major. The aim of this proposal is: to link the syllabusestablished in the specialty with these medical alternative and, at the same time, to promote it as a current and beneficial therapy in the modern world to achieve motivation in the future professionals. Starting from the link of the specialty-comprising Natural andTraditional Medicine in its study- with the paramedic personnel who is in charge ofpreparing the drugs (phyto and api medications) thus, knowledge about the active plants should be developed having as an advantage the application of those medications which do not produce adverse effects when administered. In each of the topics the modalities ofapi and phyto medications, acupuncture, stimulating exercises, massages and other terms are incorporated to encourage students to investigative systematically and apply knowledge obtained by experience or study in the daily practice (AU)

Propuesta metodológica. Vinculación del programa farmacología I con la medicina natural tradicional. Perfil de servicios farmacéuticos: Methodological proposal. Linking the syllabus of Pharmacology I with Natural Traditional Medicine. Profile of Pharmaceutical Services

Nuestro trabajo aborda la propuesta de incorporación de los conocimientos de la Medicina Natural Tradicional en el programa de Farmacología I que se imparte en la formación completa del perfil de Servicios Farmacéuticos de la Carrera Tecnología de la Salud, con el objetivo de vincular el programa de estudio y sus modalidades, y de esta forma promover la disciplina como una terapia actual y beneficiosa en el mundo moderno, logrando motivar a los profesionales en formación, partiendo de la vinculación de la especialidad (que abarca la Medicina Natural y Tradicional en su estudio) con el farmacéutico, personal paramédico que se encarga de la preparación de los medicamentos fitofármacos y apifármacos. Se impone entonces un sólido conocimiento de las plantas activas, teniendo como principal ventaja la aplicación de estos medicamentos que no implican efectos secundarios en su administración al paciente. Para lo cual incorporamos en cada uno de los temas las modalidades como apifármacos, fitofármacos, acupuntura, ejercicios estimuladores, masajes y otras que comprenden la disciplina, lo que permitirá lograr motivar a los estudiantes en formación a la investigación constante y aplicar los conocimientos adquiridos en la práctica diaria como criterio de la verdad.

This work is about a proposal to incorporate knowledge of Natural and Traditional Medicine in the syllabus of Pharmacology I, a subject that is taught in the profile of Pharmaceutical Services at Health Technology Major. The aim of this proposal is: to link the syllabus established in the specialty with these medical alternative and, at the same time, to promote it as a current and beneficial therapy in the modern world to achieve motivation in the future professionals. Starting from the link of the specialty-comprising Natural and Traditional Medicine in its study- with the paramedic personnel who is in charge of preparing the drugs (phyto and api medications) thus, knowledge about the active plants should be developed having as an advantage the application of those medications which do not produce adverse effects when administered. In each of the topics the modalities of api and phyto medications, acupuncture, stimulating exercises, massages and other terms are incorporated to encourage students to investigative systematically and apply knowledge obtained by experience or study in the daily practice.