ORCID Profile
0000-0001-8925-3589
Current Organisation
Queen's University
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Publisher: SAGE Publications
Date: 16-01-2013
Abstract: Autologous osteochondral cartilage repair is a valuable reconstruction option for cartilage defects, but the accuracy to harvest and deliver osteochondral grafts remains problematic. We investigated whether image-guided methods (optically guided and template guided) can improve the outcome of these procedures. Fifteen sheep were operated to create traumatic chondral injuries in each knee. After 4 months, the chondral defect in one knee was repaired using (a) conventional approach, (b) optically guided method, or (c) template-guided method. For both image-guided groups, harvest and delivery sites were preoperatively planned using custom-made software. During optically guided surgery, instrument position and orientation were tracked and superimposed onto the surgical plan. For the template-guided group, plastic templates were manufactured to allow an exact fit between template and the joint anatomy. Cylindrical holes within the template guided surgical tools according to the plan. Three months postsurgery, both knees were harvested and computed tomography scans were used to compare the reconstructed versus the native pre-injury joint surfaces. For each repaired defect, macroscopic (International Cartilage Repair Society [ICRS]) and histological repair (ICRS II) scores were assessed. Three months after repair surgery, both image-guided surgical approaches resulted in significantly better histology scores compared with the conventional approach (improvement by 55%, P 0.02). Interestingly, there were no significant differences found in cartilage surface reconstruction and macroscopic scores between the image-guided and the conventional surgeries.
Publisher: Elsevier BV
Date: 02-2014
DOI: 10.1016/J.JELEKIN.2013.10.012
Abstract: Bilateral knee strength evaluations of unilateral anterior cruciate ligament (ACL) deficient patients using isokinetic dynamometry are commonly performed in rehabilitation settings. The most frequently-used outcome measure is the peak moment value attained by the knee extensor and flexor muscle groups. However, other strength curve features may also be of clinical interest and utility. The purpose of this investigation was to identify, using Principal Component Analysis (PCA), strength curve features that explain the majority of variation between the injured and uninjured knee, and to assess the capabilities of these features to detect the presence of injury. A mixed gender cohort of 43 unilateral ACL deficient patients performed 6 continuous concentric knee extension and flexion repetitions bilaterally at 60°s(-1) and 180°s(-1) within a 90° range of motion. Moment waveforms were analyzed using PCA, and binary logistic regression was used to develop a discriminatory decision rule. For all directions and speeds, a statistically significant overall reduction in strength was noted for the involved knee in comparison to the uninvolved knee. The discriminatory decision rule yielded a specificity and sensitivity of 60.5% and 60.5%, respectively, corresponding to an accuracy of ∼62%. As such, the curve features extracted using PCA enabled only limited clinical usefulness in discerning between the ACL deficient and contra lateral, healthy knee. Improvement in discrimination capabilities may perhaps be achieved by consideration of different testing speeds and contraction modes, as well as utilization of other data analysis techniques.
Publisher: Springer Science and Business Media LLC
Date: 07-07-2015
DOI: 10.1007/S11548-015-1249-3
Abstract: Mosaic arthroplasty is a surgical technique in which a set of cylindrical osteochondral grafts is transplanted from non-load-bearing areas of the joint to repair damaged articular cartilage. Incongruity between the graft surface and the adjacent cartilage at the repair site results in inferior clinical outcomes. This paper compares technical outcome using three mosaic arthroplasty techniques (conventional, optoelectronic, and patient-specific template) on femur models. Three distinct sets of femur models with defects were created. Preoperatively, the harvest and delivery sites were planned using custom software. Five orthopedic surgeons were recruited each surgeon performed each of the three surgical techniques on each of the three bone models with defect. During the optoelectronic trials, the instrument position and orientation were tracked and superimposed onto the surgical plan. For the patient-specific template trials, plastic templates were manufactured to fit over the defects with cylindrical holes to guide the surgical tools according to the plan. Postoperatively, the femur models were computer tomography and laser scanned. Several measures were made to compare surgical techniques: operative time surface congruency defect coverage graft surface area that is proud or recessed air volume below the grafts and distance and angle of the grafts from the surgical plan. The patient-specific template and optoelectronic techniques resulted in improved surface congruency, defect surface coverage, and below-graft air gap volume in comparison with the conventional technique. However, the conventional technique had a shorter operative time. Image-guided techniques can improve the accuracy of mosaic arthroplasty, which could result in better clinical outcomes.
Publisher: Springer Science and Business Media LLC
Date: 20-06-2015
DOI: 10.1007/S00464-015-4260-4
Abstract: Energy devices can result in devastating complications to patients. Yet, they remain poorly understood by trainees and surgeons. A single-institution pilot study suggested that structured simulation improves knowledge of the safe use of electrosurgery (ES) among trainees (Madani et al. in Surg Endosc 28(10):2772-2782, 2014). The purpose of this study was to estimate the extent to which the addition of this structured bench-top simulation improves ES knowledge across multiple surgical training programs. Trainees from 11 residency programs in Canada, the USA and UK participated in a 1-h didactic ES course, based on SAGES' Fundamental Use of Surgical Energy™ (FUSE) curriculum. They were then randomized to one of two groups: an unstructured hands-on session where trainees used ES devices (control group) or a goal-directed hands-on training session (Sim group). Pre- and post-curriculum (immediately and 3 months after) knowledge of the safe use of ES was assessed using separate examinations. Data are expressed as mean (SD) and N (%), *p < 0.05. A total of 289 (145 control 144 Sim) trainees participated, with 186 (96 control 90 Sim) completing the 3-month assessment. Baseline characteristics were similar between the two groups. Total score on the examination improved from 46% (10) to 84% (10)* for the entire cohort, with higher post-curriculum scores in the Sim group compared with controls [86% (9) vs. 83% (10)*]. All scores declined after 3 months, but remained higher in the Sim group [72% (18) vs. 64% (15)*]. Independent predictors of 3-month score included pre-curriculum score and participation in a goal-directed simulation. This multi-institutional study confirms that a 2-h curriculum based on the FUSE program improves surgical trainees' knowledge in the safe use of ES devices across training programs with various geographic locations and resident volumes. The addition of a structured interactive bench-top simulation component further improved learning.
Publisher: Springer Science and Business Media LLC
Date: 27-09-2013
DOI: 10.1007/S00198-013-2487-2
Abstract: The study rationale was to provide a detailed overview of the costs for femoral neck fracture treatment with internal fixation in the Netherlands. Mean total costs per patient at 2-years follow-up were 19,425. Costs were higher for older, less healthy patients. Results are comparable to internationally published costs. The aim of this study was to provide a detailed overview of the cost and healthcare consumption of patients treated for a hip fracture with internal fixation. A secondary aim was to compare costs of patients who underwent a revision surgery with patients who did not. The study was performed alongside the Dutch s le of an international randomized controlled trial, concerning femoral neck fracture patients treated with internal fixation. Patient characteristics and healthcare consumption were collected. Total follow-up was 2 years. A societal perspective was adopted. Costs included hospital costs during primary stay and follow-up, and costs related to rehabilitation and changes in living situation. Costs were compared between non-revision surgery patients, implant removal patients, and revision arthroplasty patients. A total of 248 patients were included (mean age 71 years). Mean total costs per patient at 2-years follow-up were 19,425. In the non-revision surgery patients total costs were 17,405 (N = 137), in the implant removal patients 10,066 (N = 38), and in the revision arthroplasty patients 26,733 (N = 67). The main contributing costs were related to the primary surgery, admission days, physical therapy, and revision surgeries. The main determinant was the costs of admission to a rehabilitation center/nursing home. Costs were specifically high in elderly with comorbidity, who were less independent pre-fracture, and have a longer admission to the hospital and/or a nursing home. Costs were also higher in revision surgery patients. The 2-years follow-up costs in our study were comparable to published costs in other Western societies.
Publisher: SAGE Publications
Date: 15-01-2020
Abstract: Persistent anterolateral rotatory laxity after anterior cruciate ligament (ACL) reconstruction (ACLR) has been correlated with poor clinical outcomes and graft failure. We hypothesized that a single-bundle, hamstring ACLR in combination with a lateral extra-articular tenodesis (LET) would reduce the risk of ACLR failure in young, active in iduals. Randomized controlled trial Level of evidence, 1. This is a multicenter, prospective, randomized clinical trial comparing a single-bundle, hamstring tendon ACLR with or without LET performed using a strip of iliotibial band. Patients 25 years or younger with an ACL-deficient knee were included and also had to meet at least 2 of the following 3 criteria: (1) grade 2 pivot shift or greater, (2) a desire to return to high-risk ivoting sports, (3) and generalized ligamentous laxity (GLL). The primary outcome was ACLR clinical failure, a composite measure of rotatory laxity or a graft rupture. Secondary outcome measures included the P4 pain scale, Marx Activity Rating Scale, Knee injury Osteoarthritis and Outcome Score (KOOS), International Knee Documentation Committee score, and ACL Quality of Life Questionnaire. Patients were reviewed at 3, 6, 12, and 24 months postoperatively. A total of 618 patients (297 males 48%) with a mean age of 18.9 years (range, 14-25 years) were randomized. A total of 436 (87.9%) patients presented preoperatively with high-grade rotatory laxity (grade 2 pivot shift or greater), and 215 (42.1%) were diagnosed as having GLL. There were 18 patients lost to follow-up and 11 who withdrew (~5%). In the ACLR group, 120/298 (40%) patients sustained the primary outcome of clinical failure, compared with 72/291 (25%) in the ACLR+LET group (relative risk reduction [RRR], 0.38 95% CI, 0.21-0.52 P .0001). A total of 45 patients experienced graft rupture, 34/298 (11%) in the ACLR group compared with 11/291 (4%) in the ACL+LET group (RRR, 0.67 95% CI, 0.36-0.83 P .001). The number needed to treat with LET to prevent 1 patient from graft rupture was 14.3 over the first 2 postoperative years. At 3 months, patients in the ACLR group had less pain as measured by the P4 ( P = .003) and KOOS ( P = .007), with KOOS pain persisting in favor of the ACLR group to 6 months ( P = .02). No clinically important differences in patient-reported outcome measures were found between groups at other time points. The level of sports activity was similar between groups at 2 years after surgery, as measured by the Marx Activity Rating Scale ( P = .11). The addition of LET to a single-bundle hamstring tendon autograft ACLR in young patients at high risk of failure results in a statistically significant, clinically relevant reduction in graft rupture and persistent rotatory laxity at 2 years after surgery. NCT02018354 ( ClinicalTrials.gov identifier)
Publisher: SLACK, Inc.
Date: 07-2013
DOI: 10.3928/01477447-20130624-13
Abstract: This study assesses femoral neck shortening and its effect on gait pattern and muscle strength in patients with femoral neck fractures treated with internal fixation. Seventy-six patients from a multicenter randomized controlled trial participated. Patient characteristics and Short Form 12 and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were collected. Femoral neck shortening, gait parameters, and maximum isometric forces of the hip muscles were measured and differences between the fractured and contralateral leg were calculated. Variables of patients with little or no shortening, moderate shortening, and severe shortening were compared using univariate and multivariate analyses. Median femoral neck shortening was 1.1 cm. Subtle changes in gait pattern, reduced gait velocity, and reduced abductor muscle strength were observed. Age, weight, and Pauwels classification were risk factors for femoral neck shortening. Femoral neck shortening decreased gait velocity and seemed to impair gait symmetry and physical functioning. In conclusion, internal fixation of femoral neck fractures results in permanent physical limitations. The relatively young and healthy patients in our study seem capable of compensating. Attention should be paid to femoral neck shortening and proper correction with a heel lift, as inadequate correction may cause physical complaints and influence outcome.
Publisher: Springer Berlin Heidelberg
Date: 2011
DOI: 10.1007/978-3-642-23623-5_24
Abstract: This paper describes a computer system to visualize the location and alignment of an arthroscope using augmented virtuality. A 3D computer model of the patient's joint (from CT) is shown, along with a model of the tracked arthroscopic probe and the projection of the camera image onto the virtual joint. A user study, using plastic bones instead of live patients, was made to determine the effectiveness of this navigated display the study showed that the navigated display improves target localization in novice residents.
Publisher: Elsevier BV
Date: 05-2012
Publisher: Elsevier BV
Date: 03-2003
Publisher: Springer Science and Business Media LLC
Date: 02-2014
DOI: 10.1007/S00167-014-2835-6
Abstract: The purpose of this study was to estimate the radiographic prevalence of CAM-type femoroacetabular impingement (FAI) in elderly patients (≥ 50 years) who have undergone internal fixation for femoral neck fracture. A total of 187 frog-leg lateral radiographs of elderly patients who underwent internal fixation for a femoral neck fracture were reviewed by two independent reviewers. The alpha angle, beta angle, and femoral head-neck offset ratio were calculated. The presence of two abnormal radiographic parameters was deemed to be diagnostic of radiographic CAM-type impingement. Radiographic CAM-type FAI was identified in 157 out of 187 (84 %) patients who underwent internal fixation for fractures of the femoral neck. Moderate-to-good inter-observer reliability was achieved in the measurement of radiographic parameters. With reference to fracture subtypes and prevalence of radiographic features of CAM-type morphology, 97 (72 %) out of 134 patients were positive for CAM in Garden subtypes I and II, whereas 49 (85.9 %) out of 57 patients had radiographic CAM in Garden III and IV subtypes. There was a high prevalence of CAM-type FAI in patients that underwent surgical fixation of femoral neck fractures. This is significantly higher than the reported prevalence in non-fracture patient populations. The high prevalence of CAM morphology could be related to several factors, including age, fracture morphology, quality of reduction, type of fixation, and fracture healing.
Publisher: Wiley
Date: 2013
DOI: 10.1002/BTPR.1670
Abstract: Confronted with articular cartilage's limited capacity for self-repair, joint resurfacing techniques offer an attractive treatment for damaged or diseased tissue. Although tissue engineered cartilage constructs can be created, a substantial number of cells are required to generate sufficient quantities of tissue for the repair of large defects. As routine cell expansion methods tend to elicit negative effects on chondrocyte function, we have developed an approach to generate phenotypically stable, large-sized engineered constructs (≥3 cm(2) ) directly from a small amount of donor tissue or cells (as little as 20,000 cells to generate a 3 cm(2) tissue construct). Using rabbit donor tissue, the bioreactor-cultivated constructs were hyaline-like in appearance and possessed a biochemical composition similar to native articular cartilage. Longer bioreactor cultivation times resulted in increased matrix deposition and improved mechanical properties determined over a 4 week period. Additionally, as the anatomy of the joint will need to be taken in account to effectively resurface large affected areas, we have also explored the possibility of generating constructs matched to the shape and surface geometry of a defect site through the use of rapid-prototyped defect tissue culture molds. Similar hyaline-like tissue constructs were developed that also possessed a high degree of shape correlation to the original defect mold. Future studies will be aimed at determining the effectiveness of this approach to the repair of cartilage defects in an animal model and the creation of large-sized osteochondral constructs.
Publisher: Elsevier BV
Date: 12-2011
DOI: 10.1016/J.JELEKIN.2011.08.010
Abstract: This investigation assessed whether a measure of moment curve shape similarity, and a measure quantifying curve magnitude differences, enables differentiation between types (sincere vs. feigned) and levels (maximal vs. submaximal) of effort exerted during isokinetic testing of the knee. Healthy participants (n=37) performed four sets of six concentric knee extension-flexion repetitions on two occasions. The sets consisted of: (1) maximal effort (2) self-perceived 75% of maximal effort (3) self-perceived 50% of maximal effort and (4) a set attempting to feign injury. Average cross-correlation and percent root mean square difference values were computed between moment curves in each direction. Logistic regression was used to derive decision rules for differentiating between maximal and submaximal effort levels and between sincere and feigned effort types. Using a cutoff criteria corresponding to 100% specificity, maximal effort production could be ascertained with 96% sensitivity within the s le. Feigned efforts, however, could be ascertained with only 31% sensitivity due to overlap with sincere submaximal effort. Using the proposed models, clinicians may be able to ascertain whether maximal efforts were produced during isokinetic knee musculature testing. Additionally, evidence regarding participant's intentions with regard to influencing test results may be gauged, although to a lesser extent.
Publisher: Elsevier BV
Date: 2017
DOI: 10.1016/J.ARTHRO.2016.05.041
Abstract: The purpose of this study was to examine the safety of an arthroscopic technique for acromioclavicular joint (ACJ) reconstruction by investigating its proximity to important neurovascular structures. Six shoulders from 4 cadaveric specimens were used for ACJ reconstruction in this study. The procedure consists of performing an arthroscopic acromioclavicular (AC) reduction with a double button construct, followed by coracoclavicular ligament reconstruction without drilling clavicular tunnels. Shoulders were subsequently dissected in order to identify and measure distances to adjacent neurovascular structures. The suprascapular artery and nerve were the closest neurovascular structures to implanted materials. The mean distances were 8.2 (standard deviation [SD] = 3.6) mm to the suprascapular nerve and 5.6 (SD = 4.2) mm to the suprascapular artery. The mean distance of the suprascapular nerve from implants was found to be greater than 5 mm (P = .040), while the distance to the suprascapular artery was not (P > .5). Neither difference was statistically significant (P = .80 for artery P = .08 for nerve). Mini-open, arthroscopically assisted ACJ reconstruction safely avoids the surrounding nerves, with no observed damage to any neurovascular structures including the suprascapular nerve and artery, and may be a viable alternative to open techniques. However, surgeons must remain cognizant of possible close proximity to the suprascapular artery. This study represents an evaluation of the safety and feasibility of a minimally invasive ACJ reconstruction as it relates to the proximity of neurovascular structures.
Publisher: Wiley
Date: 29-10-2013
DOI: 10.1111/AOR.12199
Abstract: Joint resurfacing techniques offer an attractive treatment for damaged or diseased cartilage, as this tissue characteristically displays a limited capacity for self-repair. While tissue-engineered cartilage constructs have shown efficacy in repairing focal cartilage defects in animal models, a substantial number of cells are required to generate sufficient quantities of tissue for the repair of larger defects. In a previous study, we developed a novel approach to generate large, scaffold-free cartilaginous constructs from a small number of donor cells (20 000 cells to generate a 3-cm(2) tissue construct). As comparable thicknesses to native cartilage could be achieved, the purpose of the present study was to assess the ability of these constructs to survive implantation as well as their potential for the repair of critical-sized chondral defects in a rabbit model. Evaluated up to 6 months post-implantation, allogenic constructs survived weight bearing without a loss of implant fixation. Implanted constructs appeared to integrate near-seamlessly with the surrounding native cartilage and also to extensively remodel with increasing time in vivo. By 6 months post-implantation, constructs appeared to adopt both a stratified (zonal) appearance and a biochemical composition similar to native articular cartilage. In addition, constructs that expressed superficial zone markers displayed higher histological scores, suggesting that transcriptional prescreening of constructs prior to implantation may serve as an approach to achieve superior and/or more consistent reparative outcomes. As the results of this initial animal study were encouraging, future studies will be directed toward the repair of chondral defects in more mechanically demanding anatomical locations.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2014
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2016
Publisher: Elsevier BV
Date: 12-2005
DOI: 10.1016/J.INJURY.2005.05.008
Abstract: To review the functional outcome of patients with complex tibial plateau fractures treated with fine-wire fixation. Retrospective review with follow-up of patients in outpatient clinic. Tertiary trauma center. All patients who had fine-wire fixation for tibial plateau fractures between 1996 and January 2001 were reviewed. Fine-wire fixation with/without limited internal fixation for complex tibial plateau fractures. Knee range of motion, adequacy of articular surface reduction, mechanical axis, Knee Society Clinical Rating Scale and Short-Form 36 Health Questionnaire. Eighteen of twenty-one eligible patients were available for follow-up. There were 14 Shatzker VI and 4 V fractures. Seven fractures were open. Average follow-up was 28.2 months. All fractures united. There were three cases of delayed union, all progressed to union following additional procedures and bone grafting. There were no cases of osteomyelitis, septic arthritis or deep vein thrombosis. Seven patients had Knee Society Clinical Rating Scores of good/excellent (38.9%), and 11 had fair oor scores (61.1%). Abnormal mechanical axes and multiple co-morbid injuries were associated with poorer outcomes. Although SF-36 scores were lower in the study group compared to matched population norms, 15 of 18 patients had full or partial return to pre-injury levels of functioning. Fine-wire fixation with limited internal fixation is a satisfactory method of managing complex high-energy fractures of the tibial plateau where soft tissue injury and bony comminution make traditional techniques of open reduction and internal fixation unsuitable.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2009
Publisher: Elsevier BV
Date: 12-2012
DOI: 10.1016/J.INJURY.2012.08.061
Abstract: Patients with hip fractures are older and often present many co-morbidities, including dementia. These patients cannot answer quality of life questionnaires and are generally excluded from trials. We hypothesized that a significant number of patients are being excluded from these studies and this may impact outcomes. This was a two part study the first analyzing databases of two ongoing large-scale multi-centred hip fracture trials and the second being a systematic review. The FAITH and HEALTH studies were analyzed for exclusion incidence directly related to dementia. The second part consisted of a systematic search of all relevant studies within the last 20 years. In the FAITH study, a total of 1690 subjects were excluded, 375 (22.2%) of which were due to dementia or cognitive impairment. In the HEALTH study, 575 were excluded with dementia/cognitive impairment representing 207 patients (36%). Following the systematic review, 251 articles were identified 17 of which were retained. The overall prevalence of dementia was 27.9% (range 2-51%). Only two studies compared demented and non-demented groups. In these studies significant increases in both mortality and complications were found. In summary, when investigating hip fractures, choosing appropriate objective endpoints is essential to ensure results are also applicable to patients with dementia.
Publisher: Elsevier BV
Date: 08-2012
DOI: 10.1016/J.PTSP.2011.09.002
Abstract: To assess the reproducibility of isokinetic eccentric and concentric knee extension and flexion strength indices obtained at two different angular velocities. Cohort study. University human performance laboratory. 45 healthy physically active young adults (25 males). A non reciprocal protocol of concentric and eccentric contractions of the knee extensors and flexors was performed at 30 and 120°/s. Strength indices evaluated included peak moment dynamic control ratios and the difference between eccentric and concentric ratio at the two angular velocities. No evidence for inter-test bias in any of the strength indices was noted. Measurement precision for peak moment, as quantified using ratio limits of agreement, suggest that scores may be expected to vary up to 15% for the knee extensors in both eccentric and concentric contraction modes. An error of up to 19% was calculated for the peak moment scores of the knee flexors. Intraclass correlation coefficients revealed fairly robust preservation of participants' rank order for the majority of strength indices (>0.85). Isokinetic-related indices of knee muscles performance enable an acceptable level of detection of expected changes in muscular strength parameters as a result of planned interventions.
Publisher: Springer Science and Business Media LLC
Date: 16-08-2011
DOI: 10.1007/S00167-011-1638-2
Abstract: Success of mosaic arthroplasty requires that the transplanted plugs be positioned to reconstruct the curvature and height of the original articular surface. This case report demonstrates how to achieve correct plug positioning using patient-specific instrument guides manufactured on a 3D printer. Using a 3D computer model of bone and cartilage, the harvesting of plugs and their placement at the defect site was planned on the computer. Instrument guides were manufactured in thermoplastic on a 3D printer the bottom surface of the guides fit to the contour of the knee and the top surface contained holes to precisely position the surgical instruments. The instrument guides were used on a young female patient to repair a large articular cartilage defect in the left knee. The patient showed an increased range of motion in the knee and also a decrease in pain and discomfort at her 2-year follow-up. A CT arthrogram at 2 years postoperative showed a smooth and appropriate contour of the reconstructed cartilage over the defect. Image-based preoperative planning and the use of patient-specific instrument guides can yield a good patient outcome without requiring optically tracked intraoperative guidance.
Publisher: Elsevier BV
Date: 07-2000
Publisher: Springer Science and Business Media LLC
Date: 08-01-2012
Abstract: Surgeons in the Netherlands, Canada and the US participate in the FAITH trial (Fixation using Alternative Implants for the Treatment of Hip fractures). Dutch sites are managed and visited by a financed central trial coordinator, whereas most Canadian and US sites have local study coordinators and receive per patient payment. This study was aimed to assess how these different trial management strategies affected trial performance. Details related to obtaining ethics approval, time to trial start-up, inclusion, and percentage completed follow-ups were collected for each trial site and compared. Pre-trial screening data were compared with actual inclusion rates. Median trial start-up ranged from 41 days (P25-P75 10-139) in the Netherlands to 232 days (P25-P75 98-423) in Canada (p = 0.027). The inclusion rate was highest in the Netherlands median 1.03 patients (P25-P75 0.43-2.21) per site per month, representing 34.4% of the total eligible population. It was lowest in Canada 0.14 inclusions (P25-P75 0.00-0.28), representing 3.9% of eligible patients (p 0.001). The percentage completed follow-ups was 83% for Canadian and Dutch sites and 70% for US sites (p = 0.217). In this trial, a central financed trial coordinator to manage all trial related tasks in participating sites resulted in better trial progression and a similar follow-up. It is therefore a suitable alternative for appointing these tasks to local research assistants. The central coordinator approach can enable smaller regional hospitals to participate in multicenter randomized controlled trials. Circumstances such as available budget, s le size, and geographical area should however be taken into account when choosing a management strategy. ClinicalTrials.gov: NCT00761813
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2014
Publisher: Springer Science and Business Media LLC
Date: 26-06-2014
Publisher: Elsevier BV
Date: 11-2016
DOI: 10.1016/J.CLINBIOMECH.2016.09.004
Abstract: Evaluating the dynamic knee function of patients after anterior cruciate ligament reconstruction is a challenge. A variety of objective tests have been developed but for various reasons few are regularly used in the clinic. It may be practical to perform the step-up-and-over test with an accelerometer. A control group (N=26) and an experimental group with a reconstructed anterior cruciate ligament (N=25) completed questionnaires quantifying subjective knee function and fear of re-injury and then completed the step-up-and-over test. Results showed that the experimental group performed differently than the control group for the step-up-and-over test's Lift Symmetry and Impact Symmetry (P<0.05) and performance on these measures was related to the participant's subjective knee function (ρ=-0.46, P<0.01 ρ=-0.33, P<0.05, respectively). Supplemental results for in idual leg performance and the patient's fear of re-injury are also reported and discussed. Performance on the step-up-and-over test is different for participants with anterior cruciate ligament reconstruction than for those with intact anterior cruciate ligaments, and that performance is related to one's opinion of their knee's function.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-04-0009
Abstract: Work-hour restrictions as set forth by the Accreditation Council for Graduate Medical Education (ACGME) and other governing bodies have forced training programs to seek out new learning tools to accelerate acquisition of both medical skills and knowledge. As a result, competency-based training has become an important part of residency training. The purpose of this study was to directly compare arthroscopic skill acquisition in both high-fidelity and low-fidelity simulator models and to assess skill transfer from either modality to a cadaveric specimen, simulating intraoperative conditions. Forty surgical novices (pre-clerkship-level medical students) voluntarily participated in this trial. Baseline demographic data, as well as data on arthroscopic knowledge and skill, were collected prior to training. Subjects were randomized to 5-week independent training sessions on a high-fidelity virtual reality arthroscopic simulator or on a bench-top arthroscopic setup, or to an untrained control group. Post-training, subjects were asked to perform a diagnostic arthroscopy on both simulators and in a simulated intraoperative environment on a cadaveric knee. A more difficult surprise task was also incorporated to evaluate skill transfer. Subjects were evaluated using the Global Rating Scale (GRS), the 14-point arthroscopic checklist, and a timer to determine procedural efficiency (time per task). Secondary outcomes focused on objective measures of virtual reality simulator motion analysis. Trainees on both simulators demonstrated a significant improvement (p 0.05) in arthroscopic skills compared with baseline scores and untrained controls, both in and ex vivo. The virtual reality simulation group consistently outperformed the bench-top model group in the diagnostic arthroscopy crossover tests and in the simulated cadaveric setup. Furthermore, the virtual reality group demonstrated superior skill transfer in the surprise skill transfer task. Both high-fidelity and low-fidelity simulation trainings were effective in arthroscopic skill acquisition. High-fidelity virtual reality simulation was superior to bench-top simulation in the acquisition of arthroscopic skills, both in the laboratory and in vivo. Further clinical investigation is needed to interpret the importance of these results.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2009
Start Date: 2008
End Date: 2011
Funder: Canadian Institutes of Health Research
View Funded ActivityStart Date: 2012
End Date: 2015
Funder: Canadian Institutes of Health Research
View Funded ActivityStart Date: 2012
End Date: 2014
Funder: Natural Sciences and Engineering Research Council of Canada
View Funded ActivityStart Date: 2006
End Date: 2007
Funder: Canadian Institutes of Health Research
View Funded ActivityStart Date: 2012
End Date: 2013
Funder: Canadian Institutes of Health Research
View Funded ActivityStart Date: 2006
End Date: 2010
Funder: Canadian Institutes of Health Research
View Funded Activity