ABSTRACT
OBJECTIVES: Variation exists in the capabilities of electronic healthcare records (EHRs) systems and the frequency of their use by primary care physicians (PCPs) from different settings. We aimed to examine the factors associated with everyday EHRs use by PCPs, characterise the EHRs features available to PCPs, and to identify the impact of practice settings on feature availability. STUDY DESIGN: Cross-sectional study. METHODS: PCPs from 20 countries completed cross-sectional online survey between June and September 2020. Responses which reported frequency of EHRs use were retained. Associations between everyday EHRs use and PCP and practice factors (country, urbanicity, and digital maturity) were explored using multivariable logistic regression analyses. The effect of practice factors on the variation in availability of ten EHRs features was estimated using Cramer's V. RESULTS: Responses from 1520 out of 1605 PCPs surveyed (94·7%) were retained. Everyday EHRs use was reported by 91·2% of PCPs. Everyday EHRs use was associated with PCPs working >28 h per week, having more years of experience using EHRs, country of employment, and higher digital maturity. EHRs features concerning entering, and retrieving data were available to most PCPs. Few PCPs reported having access to tools for 'interactive patient education' (37·3%) or 'home monitoring and self-testing of chronic conditions' (34·3%). Country of practice was associated with availability of all EHRs features (Cramer's V range: 0·2-0·6), particularly with availability of tools enabling patient EHRs access (Cramer's V: 0·6, P < 0.0001). Greater feature availability of EHRs features was observed with greater digital maturity. CONCLUSIONS: EHRs features intended for patient use were uncommon across countries and levels of digital maturity. Systems-level research is necessary to identify the country-specific barriers impeding the implementation of EHRs features in primary care, particularly of EHRs features enabling patient interaction with EHRs, to develop strategies to improve systems-wide EHRs use.
ABSTRACT
INTRODUCTION: The anterior cruciate ligament (ACL) is composed of an infinite number of fibers whose individual anatomical and biomechanical features have been well defined. Although numerous biomechanical studies have shown that reconstruction that is as anatomical as possible results in better control of rotational laxity, very few studies have investigated the surface area of tibial and femoral insertion sites in these reconstructions. The aim of this study was to compare the surface areas of tibial and femoral insertion sites in single and double bundle reconstructions and correlate these findings with the isometry profile obtained. Our hypothesis was that double bundle (DB) reconstruction results in better filling of the native ACL footprint thus increasing the biomechanical value of available graft tissue. PATIENTS AND METHODS: Forty-six patients underwent computer navigated ACL using hamstring tendons: 23 underwent single bundle (SB) and 23 DB reconstruction. The Praxim navigation station equipped with ACL logics software made it possible to digitize insertion site footprints, register perioperative data for graft position as well as anteroposterior and rotational laxities and pivot shift. RESULTS: There was a statistically significant difference between the two groups for tibial and femoral insertion site surface areas: 71 mm(2) ± 17 (SB) versus 99.9 mm(2) ± 30 (DB) for the tibia, 67 ± 11 mm(2) (SB) versus 96.9 mm(2) ± 28 (DB) for the femur. Isometry profiles showed that anisometry was favorable in all cases: 2.5 mm ± 2 for SB; 2.9 mm ± 2 for the anteromedial bundle (AMB) with DB and 9.6 mm ± 3.7 for the posterolateral bundle. When both groups were combined, there was a statistically significant correlation between the size of tibial insertion surface area and anteroposterior and rotational laxity. DISCUSSION: This study confirms that better filling of native ACL footprint surface areas results in better control of anteroposterior laxity. LEVEL OF EVIDENCE: Level IV.
Subject(s)
Anterior Cruciate Ligament Injuries , Anterior Cruciate Ligament Reconstruction/methods , Anterior Cruciate Ligament/surgery , Knee Injuries/surgery , Biomechanical Phenomena , Female , Humans , Male , Surgery, Computer-AssistedABSTRACT
On October 8th 2005, a violent earthquake struck the northern region of Pakistan resulting in a large number of injuries and deaths. In response to this catastrophe, the Swiss Agency for Development and Cooperation (SDC) offered logistic support, including material and medical staff. After evaluating the needs, the SDC sent two surgeons to the city of Mansehra for a short term mission. At that site a college had been transformed into a field hospital by a multidisciplinary Pakistani team, already busy at work. Up to 200 casualties per day were brought to that center for a first surgical procedure consisting in debridement, application of traction, or external fixation. In total, more than 2000 people were treated during this two week mission.
