Endometriosis and dyspareunia: Solving the enigma.

Introduction: Endometriosis is a chronic oestrogen-dependent disease that affects 1 in 10 women of childbearing age. Half of these women have deep dyspareunia. The presence of this symptom has been shown to negatively affect your quality of life. There are few studies in the literature that address this issue and its pathophysiology remains poorly understood. Materials and methods: A case-control study has been carried out in order to assess the multi-causality of dyspareunia in patients with endometriosis. All the patients were assessed in a unit specialising in endometriosis and pelvic pain and their disease was staged using high-resolution ultrasound following the criteria of the IDEA group. The patients were divided into two groups, patients with dyspareunia n = 45 (cases) and those without it n = 55 (controls). Results: The only element that was statistically significant in explaining the dyspareunia was the presence of nodules in the retrocervical region with p = 0.000. The odds ratio of dyspareunia in the cases group was 5.3 (95 % CI 2.2-12.5). Conclusions: Dyspareunia in patients with endometriosis is strongly dependent on the presence of nodules in the retrocervical region, although there are other factors involved that remain unknown, so more studies are still needed to understand and optimally address this symptom.

Prevalencia de consumo y exposición de tabaco en trabajadores del área de la salud / Prevalence of tobacco consumption and exposure in health care area workers

INTRODUCCIÓN: El conocimiento del consumo de tabaco en un entorno laboral de salud es fundamental para poder desarrollar medidas de gestión sobre las poblaciones vulnerables. OBJETIVO: Conocer la prevalencia de consumo de tabaco y la exposición al humo de tabaco en el ambiente laboral de la Obra Social de Empleados Públicos de Mendoza, Argentina (OSEP). MATERIALES Y MÉTODOS: Estudio transversal, descriptivo, observacional, realizado en OSEP, entre octubre del 2016 y marzo del 2017. Encuesta anónima y voluntaria; formato adaptado de la Encuesta Mundial de Tabaquismo. Análisis estadístico mediante el programa MedCalc, tablas de contingencia y χ2 (p < 0,05). RESULTADOS: Población: 1.603. Edad promedio: 42 años.63,8% mujeres. El 61,3% eran profesionales de la salud y el 22,7% personal administrativo. El 85,2% tenía nivel educativo terciario/universitario. La prevalencia de fumadores actuales fue del 22,02%, en hombres del 26,7% y mujeres del 19,5%. El 35,5% del personal administrativo era fumador actual en comparación con el 16,6% de los profesionales de la salud (p < 0,0001). El 39% de las personas con nivel educativo primario/secundario fumaban actualmente en comparación con el 18,5% de los que tenía nivel terciario/universitario (p < 0,0001). La exposición al humo de tabaco dentro del entorno laboral fue del 34,5%. CONCLUSIONES: La prevalencia global de consumo de tabaco fue del 22,02%, y la exposición al humo de tabaco fue del 34,5%. La población con mayor prevalencia de consumo de tabaco resultó ser el personal administrativo y la de menor nivel educativo

INTRODUCTION: Knowledge regarding tobacco consumption in a health work environment is essential in order to be able to develop management measures in vulnerable populations. PURPUSE: To know the prevalence of tobacco consumption and exposure to tobacco smoke in the Obra Social de Empleados Públicos de Mendoza, Argentina (OSEP) work environment. MATERIALS AND METHODS: Cross-sectional, descriptive, observational study carried out in OSEP, between October 2016 and March 2017. Anonymous and voluntary survey; format adapted from the Global Tobacco Survey. Statistical analysis using MedCalc program, contingency tables and χ2 (p < 0,05). RESULTS: Population: 1,603. Average age: 42, 63.8% women.61.3% were health professionals and 22.7% were administrative personnel.85.2% had university-level education. The prevalence of current smokers was 22.02%; in men, 26.7% and women, 19.5%.35.5% of administrative staff were current smokers compared to 16.6% of health professionals (p < 0.0001).39% of people with primary/secondary education were currently smoking compared to 18.5% of those with a university level. The exposure to tobacco smoke in the workplace was 34.5%. CONCLUSIONS: The overall prevalence of tobacco use was 22,02%, and exposure to tobacco smoke was 34,5%. The population with the highest prevalence of tobacco use proved to be the administrative staff and the lowest educational level

Survivorship of hip and knee implants in pediatric and young adult populations: analysis of registry and published data.

BACKGROUND: One of the least researched areas in orthopaedic pediatrics is the safety and effectiveness of joint replacement, in part because it is uncommon and is undertaken for a wide range of conditions not common for adult joint replacement. This study used data from the AOANJRR (Australian Orthopaedic Association National Joint Replacement Registry) to analyze the use of total hip arthroplasty (THA) and total knee arthroplasty (TKA) in the pediatric population and to provide preliminary data on the outcome of these procedures. METHODS: The AOANJRR, which is part of the ICOR (International Consortium of Orthopaedic Registries), provided information on pediatric procedures reported to the registry by hospitals undertaking arthroplasty procedures in Australia. All THA and TKA procedures reported to the registry from 1999 to 2012 were included. The cumulative percent revision and the hazard ratio from Cox proportional-hazards models were used for analysis. All tests were two-tailed, with a 5% level of significance. Additionally, an overview of the literature is presented to provide a point of reference. RESULTS: Primary conventional THA was performed in 297 patients twenty years of age or younger; the cumulative percent revision at five years was 4.5%. Primary conventional THA was performed in 975 young adults twenty-one to thirty years of age; the cumulative percent revision at five years was 5.4%. Primary THA was performed in 105 patients twenty years of age or younger; the cumulative percent revision at five years was 4.6%. Primary TKA was performed in 159 young adults twenty-one to thirty years of age; the cumulative percent revision at five years was 10.3%. CONCLUSIONS: Compared with older adults, pediatric patients and young adults undergoing THA and TKA have very different diagnoses, including a high prevalence of tumor. Although the reported rate of revision surgery is currently similar to that for older patients, the number of reported procedures and the follow-up period remain limited. It is important for registries to continue to collect and analyze data relevant to this cohort and to coordinate these activities in order to better understand the safety and effectiveness of joint arthroplasty in the pediatric population.

Review of clinical outcomes-based anchors of minimum clinically important differences in hip and knee registry-based reports and publications.

Patient-reported outcome measures are tools that allow clinicians and researchers to gauge patients' level of satisfaction and quality of life after a medical intervention. The use of patient-reported outcome measures and the clinically relevant score differentials over time as they relate to outcomes (minimum clinically important differences) has been proposed as a way to understand success and failure rates in orthopaedics. We conducted a systematic appraisal of literature in peer-reviewed journals and registry reports to measure the use that registries and other large data repositories make of minimum clinically important differences and to understand methodological approaches for such uses. Of the nineteen registry reports and 1052 articles examined, we found that only one report and two studies mentioned the use of patient-reported outcome measures and minimum clinically important differences in the context of revision rates of total knee arthroplasty and total hip arthroplasty. We conclude that although the infrastructure and efforts to routinely collect patient-reported outcome measures at registry levels do exist, there is limited use of minimum clinically important differences to understand and potentially predict clinical outcomes. We suggest advancing the global infrastructure such as the International Consortium of Orthopaedic Registries to address how research related to patient-reported outcome measures can help individual registries collaborate in the development of tools and allow aggregation of data.

Rationale, design, and implementation protocol of an electronic health record integrated clinical prediction rule (iCPR) randomized trial in primary care.

BACKGROUND: Clinical prediction rules (CPRs) represent well-validated but underutilized evidence-based medicine tools at the point-of-care. To date, an inability to integrate these rules into an electronic health record (EHR) has been a major limitation and we are not aware of a study demonstrating the use of CPR's in an ambulatory EHR setting. The integrated clinical prediction rule (iCPR) trial integrates two CPR's in an EHR and assesses both the usability and the effect on evidence-based practice in the primary care setting. METHODS: A multi-disciplinary design team was assembled to develop a prototype iCPR for validated streptococcal pharyngitis and bacterial pneumonia CPRs. The iCPR tool was built as an active Clinical Decision Support (CDS) tool that can be triggered by user action during typical workflow. Using the EHR CDS toolkit, the iCPR risk score calculator was linked to tailored ordered sets, documentation, and patient instructions. The team subsequently conducted two levels of 'real world' usability testing with eight providers per group. Usability data were used to refine and create a production tool. Participating primary care providers (n = 149) were randomized and intervention providers were trained in the use of the new iCPR tool. Rates of iCPR tool triggering in the intervention and control (simulated) groups are monitored and subsequent use of the various components of the iCPR tool among intervention encounters is also tracked. The primary outcome is the difference in antibiotic prescribing rates (strep and pneumonia iCPR's encounters) and chest x-rays (pneumonia iCPR only) between intervention and control providers. DISCUSSION: Using iterative usability testing and development paired with provider training, the iCPR CDS tool leverages user-centered design principles to overcome pervasive underutilization of EBM and support evidence-based practice at the point-of-care. The ongoing trial will determine if this collaborative process will lead to higher rates of utilization and EBM guided use of antibiotics and chest x-ray's in primary care. TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT01386047.