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Purpose: The aim of this study was to assess the sex differences in enrollment into clinical trials for Dupuytren's disease (DD), treatment efficacy, and complications. Methods: Three databases were searched; Ovid MEDLINE, Ovid EMBASE, and EBSCO CINAHL. Included studies were clinical trials on adult patients with DD. Exclusion criteria were non-English studies and other study designs. Two independent reviewers completed abstract screening, full-text review, and data extraction. The number and percentage of studies that reported ad hoc analyses for sex differences in treatment efficacy, tolerability, and complications were reported. A meta-analysis was performed on the proportion of female participants enrolled in clinical trials for DD. Results: A total of 3172 references were screened, and 59 studies were identified for full-text review. We identified 28 clinical trials for DD of which none reported secondary analyses for sex differences. Only 2 trials discussed sex differences in complications, and one trial reported sex differences in tolerability. The proportion of female participants in the meta-analysis was 19.5% [95% CI: 16.1-23.0%]. Conclusion: Sex differences in the clinical trials for DD are not widely considered in clinical trials despite their critical role. Males and females do not have equal representation in clinical trials for DD. Future studies should account for sex differences in the design and the analysis of clinical trials.
Objectif: La présente étude visait à évaluer les différences selon les sexes à l'égard de l'inscription à des études cliniques sur la maladie de Dupuytren (MD), l'efficacité du traitement et les complications. Méthodologie: Les chercheurs ont fouillé trois bases de données, soit Ovid MEDLINE, Ovid EMBASE et EBSCO CINAHL et ont retenu les études cliniques sur les patients adultes atteints de MD. Ils ont exclu les études qui n'étaient pas rédigées en anglais et qui reposaient sur d'autres méthodologies. Deux analystes indépendants ont examiné les résumés, analysé les textes intégraux et extrait les données. Ils ont rendu compte du nombre et du pourcentage d'études qui ont fait état d'analyses ponctuelles sur les différences selon les sexes à l'égard de l'efficacité du traitement, de la tolérabilité et des complications. Ils ont procédé à une méta-analyse sur la proportion de participantes inscrites aux études cliniques sur la MD. Résultats: Au total, les chercheurs ont examiné 3172 références et ont retenu 59 études en vue d'en évaluer le texte intégral. Ils ont répertorié 28 études cliniques sur la MD, et aucune ne contenait d'analyses secondaires sur les différences selon les sexes. Seulement deux études abordaient les différences selon les sexes pour ce qui est des complications, et une étude constatait des différences selon les sexes quant à la tolérabilité. Dans la méta-analyse, la proportion de participantes s'élevait à 19,5% [IC à 95% : 16,1% à 23,0%]. Conclusion: On ne tient pas tellement compte des différences selon les sexes dans les études cliniques sur la MD, malgré leur rôle capital. Les hommes et les femmes ne sont pas représentés équitablement dans les essais cliniques sur la MD. De prochaines études devraient tenir compte des différences selon les sexes au moment d'établir la méthodologie des études cliniques et de les analyser.
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Purpose: The aim of this study was to assess the impact of COVID-19 on surgical wait times for Plastic and Reconstructive Surgery (PRS) in Ontario, Canada. Methods: Ontario's wait time data has fourteen reporting categories for PRS. For each category, the mean wait time for consultation and for surgery were reported. Each category was given a priority ranging from 1 to 4. Two periods, three-month and six-month, were selected and compared to the same calendar months of the previous year. Wait times, surgical volume and percent change to the provincial wait time target were reported and compared to the baseline data. Results: This study reviewed 9563 consults and 15,000 operative cases. There was a 50% reduction in the volume of surgical consults during the study period compared to the baseline period (P = 0.004). The reduction ranged from 46% to 75% based on the reporting category. The volume of surgical cases decreased by 43% during the study period compared to the baseline period (P = 0.005). A statistically significant increase in the mean wait times for surgery was observed, involving priorities 2 to 4 (overall mean = 32 days, P ≤ 0.01). There was a 15% decrease in the percentage of surgeries meeting the provincial target times (P < 0.0001). Conclusion: COVID-19 has caused a significant reduction in the volume of cases performed in the majority of PRS categories with an overall increase in the wait times for consultation and for surgery. Recovery following COVID-19 will require strategies to address the growing volume of cases and wait times for surgery across all PRS categories.
Objectif: La présente étude vise à évaluer les effets de la COVID-19 sur les temps d'attente en vue de chirurgies plastiques et reconstructives (CPR) en Ontario, au Canada. Méthodologie: Les données sur les temps d'attente en Ontario comportent quatorze catégories de déclaration relatives aux CPR. Dans chaque catégorie, les chercheurs ont établi le temps d'attente moyen avant la consultation et l'opération et attribué à chaque catégorie une priorité de 1 à 4. Les chercheurs ont sélectionné deux périodes, de trois mois et de six mois, et les ont comparées aux mêmes mois civils de l'année précédente. Ils ont comparé le temps d'attente, le volume d'opérations et le pourcentage de changements avec les données de référence par rapport à la cible de temps d'attente ontarienne. Résultats: La présente étude portait sur 9 563 consultations et 15 000 opérations. Le nombre de consultations en chirurgie a baissé de 50% pendant la période de l'étude par rapport à la période de référence (p = 0.004). Cette baisse se situait entre 46% et 75%, en fonction de la catégorie de déclaration. Le nombre d'opérations a reculé de 43% par rapport à la période de référence (p = 0.005). Les chercheurs ont observé une augmentation statistiquement significative du temps d'attente moyen des opérations touchant les priorités 2 à 4 (moyenne globale = 32 jours, p ≤ 0.01). Le pourcentage d'opérations respectant les temps d'attente provinciaux a fléchi de 15% (p < 0.0001). Conclusion: La COVID-19 a suscité une importante réduction du nombre de cas dans la majorité des catégories de CPR et une augmentation globale des temps d'attente avant la consultation et l'opération. Des stratégies devront être mises en Åuvre lors de la reprise qui suivra la COVID-19 pour tenir compte du nombre croissant de cas et des temps d'attente avant l'opération dans toutes les catégories de CPR.
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BACKGROUND: This study aimed to assess the responsiveness of the Trapeziometacarpal Arthrosis Symptoms and Disability (TASD) questionnaire after corticosteroid injections and operative management for trapeziometacarpal osteoarthritis (TMC-OA). METHODS: This longitudinal cohort study included patients with TMC-OA who underwent treatment (corticosteroid injection or surgery). Measurements occurred at baseline and follow-up time points: 6 weeks, 3 months, 6 months, and 1 year. Patient measures were collected electronically using a data repository platform. The TASD is a validated psychometric patient-administered scale. We examined responsiveness by correlating the TASD scores with another known effective indicator of change (shortened Disabilities of the Arm, Shoulder, and Hand [QuickDASH]). Repeated score measurements over time were analyzed using analysis of variance, and correlations between questionnaires were reported with repeated measures correlation and Pearson correlation coefficients. RESULTS: The nonsurgical cohort undergoing corticosteroid injections included 31 (66%) women and 16 (34%) men, and the surgical cohort included 29 (71%) women and 12 (29%) men. Both the QuickDASH and the TASD captured a statistically significant improvement in symptom burden postoperatively (P < .0001 for both questionnaires), whereas no statistical significance was noted after corticosteroid injections (P = .45 and P = .34, respectively). There was a strong correlation between QuickDASH and TASD questionnaires (r = 0.87, P < .0001). CONCLUSIONS: The TASD is a promising TMC-OA-specific questionnaire to capture responsiveness following treatment, particularly following surgery. The responsiveness of TASD was demonstrated in the TMC-OA cohort. Further research is needed to define a minimal clinically important difference.
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PURPOSE: The aim of this study was to review the literature to determine the prevalence of cold sensitivity in upper extremity nerve compression syndromes and the impact of treating nerve compression syndromes on cold sensitivity. METHODS: Following a standardized scoping review protocol, this study included interventional and observational study designs assessing patients with cold sensitivity and upper extremity nerve compression syndromes. Review articles, case reports, and small case series (n < 5) were excluded. The abstracts and eligible full texts were screened by 2 independent reviewers. Data were extracted and reported according to PRISMA extension for scoping reviews statement. RESULTS: Three databases were searched (Ovid MEDLINE, Ovid EMBASE, and CINAHL on EBSCO); 274 references were reviewed. Fifteen studies from the database search and 8 studies from the reference search were eligible for this review (n = 23). Two interventional and 21 observational studies were identified. The most common method for assessing cold sensitivity was cold pain threshold testing (n = 12), followed by subjective patient reporting (n = 4). The Cold Intolerance Symptom Severity questionnaire was the most common validated patient-reported outcome questionnaire used in the studies (n = 3). Cold sensitivity was most commonly reported in carpal tunnel syndrome (96% of the studies). The prevalence of cold sensitivity in nerve compression syndromes ranged from 20% to 69%. Nerve decompression improved the severity of cold sensitivity in 5 of 6 studies where cold sensitivity was studied. CONCLUSIONS: There is heterogenicity in the studies assessing cold sensitivity in nerve compression syndromes. Despite moderate prevalence in patients with carpal tunnel syndrome, cold sensitivity is understudied. Within the limitations of eligible studies reviewed, surgical decompression improved the severity of cold sensitivity in some studies. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
Assuntos
Síndrome do Túnel Carpal , Síndromes de Compressão Nervosa , Síndrome do Túnel Carpal/diagnóstico , Síndrome do Túnel Carpal/cirurgia , Descompressão Cirúrgica/métodos , Humanos , Síndromes de Compressão Nervosa/diagnóstico , Procedimentos Neurocirúrgicos/métodos , Estudos Observacionais como Assunto , Extremidade Superior/cirurgiaRESUMO
INTRODUCTION: Accelerated recovery protocols have proved effective in many surgical procedures but are infrequently applied in breast reconstruction. In this study, we evaluate the impact of a structured pathway for accelerated postoperative recovery in patients undergoing microvascular breast reconstruction at a high-volume center. METHODS: We describe our care pathway for patients undergoing deep inferior epigastric artery perforator (DIEP) flap breast reconstruction at our center. We compared length of stay (LOS), complication rates, readmission rates, and cost of inpatient care before (pre-protocol (Pre-P)) and after (post-protocol (Post-P)) the implementation of the protocol. RESULTS: Patients in the Post-P group (nâ¯=â¯198) had a significant reduction in mean LOS as compared to those in the Pre-P (nâ¯=â¯183) group (3.6 +/- 0.85â¯vs. 4.7 +/-1.04 days, pâ¯=â¯0.006). There was no significant difference in the rates of major (Pre-P 16.9% vs. Post-P 14.7%, pâ¯=â¯0.71) or minor (Pre-P 21.3% vs. 17.1%, pâ¯=â¯0.22) postoperative complications between groups. The readmission rates were also similar (Pre-P 6.5% vs. Post-P 4.5, pâ¯=â¯0.69). Implementation of the protocol resulted in a significant reduction in the mean cost of in-patient care. CONCLUSION: A simple protocol for accelerated and streamlined postoperative recovery effectively reduces LOS and patient care costs following DIEP flap breast reconstruction without compromising patient safety.