Validating a transnational fracture treatment registry using a standardized method.

AIM: Subsequent to a three-month pilot phase, recruiting patients for the newly established BFCC (Baltic Fracture Competence Centre) transnational fracture registry, a validation of the data quality needed to be carried out, applying a standardized method. METHOD: During the literature research, the method of "adaptive monitoring" fulfilled the requirements of the registry and was applied. It consisted of a three-step audit process; firstly, scoring of the overall data quality, followed by source data verification of a sample size, relative to the scoring result, and finally, feedback to the registry on measures to improve data quality. Statistical methods for scoring of data quality and visualisation of discrepancies between registry data and source data were developed and applied. RESULTS: Initially, the data quality of the registry scored as medium. During source data verification, missing items in the registry, causing medium data quality, turned out to be absent in the source as well. A subsequent adaptation of the score evaluated the registry's data quality as good. It was suggested to add variables to some items in order to improve the accuracy of the registry. DISCUSSION: The application of the method of adaptive monitoring has only been published by Jacke et al., with a similar improvement of the scoring result following the audit process. Displaying data from the registry in graphs helped to find missing items and discover issues with data formats. Graphically comparing the degree of agreement between the registry and source data allowed to discover systematic faults. CONCLUSIONS: The method of adaptive monitoring gives a substantiated guideline for systematically evaluating and monitoring a registry's data quality and is currently second to none. The resulting transparency of the registry's data quality could be helpful in annual reports, as published by most major registries. As the method has been rarely applied, further successive applications in established registries would be desirable.

Arthroscopic-assisted hook plate fixation for acromioclavicular joint dislocation.

PURPOSE: We present a new technique of arthroscopic-assisted AC-hook plate fixation for acromioclavicular joint dislocation with all the advantages of minimally invasive surgery and the possibility to treat concomitant pathologies. METHODS: Initially a glenohumeral arthroscopy is performed to address concomitant intra-articular injuries. Under subacromial visualisation the drill hole for the hook of the plate can be exactly positioned in the acromion. The hook plate is put in place under visual control. RESULTS: The initial results (n = 3) are promising with good to excellent results in the Constant score [90.5 (range 82-100)] in all cases studied. The cross-body test was slightly positive in one case. The median follow-up time after the index procedure was seven months (range five to ten). CONCLUSIONS: In conclusion, arthroscopic-assisted reconstruction of acromioclavicular joint separation is feasible and may provide patients with all the benefits of AC-hook fixation with decreased risks related to open surgery. The described technique is recommended for all surgeons familiar with arthroscopic surgery.

A single prophylactic dose of pentoxifylline reduces high dependency unit time in cardiac surgery - a prospective randomized and controlled study.

BACKGROUND: The pathogenesis of the post cardiopulmonary bypass (CPB) organ dysfunction syndrome is complex, with inflammation being an important component. The purpose of this prospective, randomized and controlled study was to evaluate the effect of a single dose of pentoxifylline (PTX) prior to CPB on high dependency unit time. MATERIALS AND METHODS: We studied 39 patients undergoing aorto-coronary bypass surgery with CPB. Patients received either 5 mg kg(-1) PTX after induction of anaesthesia or saline as placebo. Haemodynamics, parameters of pulmonary function and plasma levels of tumour necrosis factor alpha (TNFalpha) and C-reactive protein (CRP) were measured after the induction of anaesthesia (pre-CPB) and after weaning from CPB (post-CPB), 1 h after the admission to the intensive care unit (ICU) and on the morning of the first postoperative day (1 POD), respectively. In addition, ventilation time and the high dependency unit time, i.e. the time till transferral to a peripheral ward, were documented. RESULTS: Patients in the PTX group had lower TNFalpha values (6.3 ng ml(-1) (4/8.2) vs 9.1 ng ml(-1) (6.5/13.7)) (median (25%/75%), p=0.021), lower systolic (28+/-7 mm Hg vs 35 +/- 9 mm Hg, mean+/-SD, p=0.011) and mean pulmonary artery pressures (21+/-5 vs 26+/-6 mm Hg, p=0.017) after admission to the ICU than control patients. Haemodynamics and pulmonary function parameters did not differ. There was a trend towards earlier weaning from the respirator in the PTX group (10.0+/-3.5 h) (min/max: 4/16; confidence interval (ConF): 1.8 h) than the control group (12.3+/-4.2 h) (min/max: 5-24; ConI: 2.4 h) (p=0.077). Patients treated with PTX could be transferred to a peripheral ward about 24 h earlier than control patients (95+/-35 h, min/max: 32/190 h; ConI: 17 h; 119+/-29 h, min/max: 66/165 h; ConI: 16 h) respectively; p=0.037). CONCLUSION(S): A single dose of PTX prior to CPB was able to reduce plasma levels of TNFalpha. In this descriptive study, there was a trend towards reduced duration of ventilation and the high dependency unit time, i.e. the time till transferral to a peripheral ward was shortened.