Acceptance of evidence based medicine (EBM) databases by Iranian medical residents using unified theory of acceptance and use of technology (UTAUT)

Objective

Physicians often need uptodate, reliable and with easy access information for clinical decisions evidence based medicine (EBM) databases can be a suitable approach to meet this need. The aim of this study was to assess the knowledge, use and factors affecting the acceptance of EBM and its databases by Iranian medical residents using UTAUT model.

Impact of renal disease on elective shoulder arthroplasty outcomes for glenohumeral osteoarthritis

BackgroundRenal disease including chronic renal disease and end-stage renal disease has been associated with the development of primary glenohumeral osteoarthritis. However, little is known about how renal disease affects outcomes after shoulder arthroplasty. Thus, the purpose of this study was to evaluate the impact of renal disease on outcomes of shoulder arthroplasty for glenohumeral osteoarthritis.MethodsThis was a retrospective review using the Nationwide Readmissions Database. Using International Classification of Diseases, 9th Revision, codes, patients who underwent shoulder arthroplasty (including total shoulder arthroplasty and reverse total shoulder arthroplasty) for primary glenohumeral osteoarthritis were identified. These patients were divided into 3 groups: no renal disease, predialysis chronic renal disease (including stages 1-5), and end-stage renal disease. Primary outcomes of interest included the risk of complications during index hospitalization as well as within 90 days of index surgery. Secondary outcomes included index hospitalization length of stay, cost, and discharge location.ResultsFrom 2010 to 2014, a total of 29,336 patients underwent shoulder arthroplasty for glenohumeral osteoarthritis. Of these 29,336, 27,928 (95.2%) patients had no renal disease, 1355 (4.6%) had predialysis chronic renal disease, and 53 (0.2%) patients had end-stage renal disease. Compared with patients with no renal disease, both predialysis chronic renal disease and end-stage renal disease patients had an increased risk of receiving blood transfusions (odds ratio [OR] = 2.04, P < .0001, and 5.37, P = .04, respectively) and experiencing any postoperative complication during the index hospitalization (OR = 2.31, P < .0001, and 3.94, P = .003, respectively). Specifically, predialysis chronic renal disease patients were at an increased risk for cardiac (OR = 1.96, P < .0001) and respiratory (OR = 1.55, P < .0001) complications as well as acute renal failure (OR = 14.70, P < .0001) postoperatively. End-stage renal disease patients were at an increased risk for cardiac (OR = 3.87, P = .003) complications as well as acute renal failure (OR = 10.35, P = .002) postoperatively. Within 90 days, end-stage renal disease patients had an increased risk of hospital readmission (OR = 8.01, P < .0001), dislocation (OR = 8.70, P = .039), and surgical site infection (OR = 19.06, P = .001). Finally, compared with patients with no renal disease, predialysis chronic renal disease and end-stage renal disease patients both had increased hospital length of stay and cost; predialysis chronic renal disease patients had an increased risk of discharge to a skilled nursing facility (OR = 1.39, P = .039).Discussion and ConclusionThis retrospective cohort study demonstrates that even predialysis chronic renal disease patients have worse outcomes compared with patients with no renal disease after shoulder arthroplasty for glenohumeral osteoarthritis. These findings serve to highlight the importance of close perioperative monitoring to prevent complications in a potentially overlooked patient population.     

Results of a French pilot database of standard of care of chronic subdural hematoma

BackgroundA registry of chronic subdural hematoma does not exist in France yet.ObjectiveTo present a monocentric pilot project of a French registry of surgical management of chronic subdural hematoma.MethodA monocentric pseudonymized formal database was created. From May 2020 to May 2021, all patients undergoing surgical evacuation of chronic subdural hematoma were entered into the database.ResultsOne hundred and twenty four surgeries from 113 patients were entered in the database. Patients’ demographic and surgical data as well as follow-up are described.ConclusionA local database is easy to implement. We propose a national registry of chronic subdural hematoma management.     

厚积薄发——中国甲状腺肿瘤临床数据库分级质量管理的建议与思考

数据库建设在甲状腺肿瘤临床研究中取得丰硕的科研成果,以大数据库为基础的临床研究引导各指南的制定和更新,推动甲状腺外科临床实践的进步。我国甲状腺肿瘤数据库建设起步较晚,中国人群的甲状腺癌的高质量循证医学证据仍有所欠缺,临床指南参考证据也仍有不足。近年来,依托互联网技术的发展和庞大的患者群体,我国甲状腺肿瘤临床数据库建设发展迅速。然而,由于缺乏数据库建设的质量控制标准,在各种临床信息数据化的过程中,随着数据可利用性的提高,真实性、完整性降低的风险大大增加。笔者结合所在中心甲状腺肿瘤数据库建设中的经验和问题,提出甲状腺肿瘤临床数据库分级质量管理的一些初步构想和建议。数据库的建设和应用过程即为从原始信息提取为最终科研论文数据的过程,我们将各级数据库信息特征总结为从0~3级数据的逐步采录过程。下一级数据的质量控制依赖于上一级数据的真实性和可利用性。随着病例信息数据的逐级转录,数据可利用性逐步上升至可临床科研应用水平,而真实性逐渐下降。数据库质量控制即为在提高可利用性的过程尽可能保证数据的真实性。其中,1级数据是数据库建设过程中数据损失风险较高,提高该级数据质量是提升数据库整体质量的基础和关键所在。本文分别从临床病历信息中的检验、病理报告（1A级）,超声报告（1B级）和文字记录（1C级）等不同层面分享了数据库质量管理的一些思考,并提出结构化的1级病历数据建议,以期改善数据库的整体质量。近年来,基于大数据的人工智能诊断、疾病预测模型等方向的研究开展如火如荼,然而,如缺乏良好的原始数据库基础,后期几乎无法改善,在大数据库的建设中可能导致“事倍功半”的尴尬局面。此类数据库的管理问题可能在各专科领域、各个国家数据库建设中普遍存在。因此,本文旨在呼吁国内同道共同关注于数据库的质量控制,从而依托不同中心数据库建设经验,群策群力,共同制定更为合理的我国甲状腺肿瘤临床数据库分级管理办法。     

Obese Class III patients at significantly greater risk of multiple complications after lumbar surgery: an analysis of 10,387 patients in the ACS NSQIP database

Background contextPrior studies on the impact of obesity on spine surgery outcomes have focused mostly on lumbar fusions, do not examine lumbar discectomies or decompressions, and have shown mixed results regarding complications. Differences in sample sizes and body mass index (BMI) thresholds for the definition of the obese versus comparison cohorts could account for the inconsistencies in the literature.PurposeThe purpose of the study was to analyze whether different degrees of obesity influence the complication rates in patients undergoing lumbar spine surgery.Study design/settingThis was a retrospective cohort analysis of prospectively collected data using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database from 2005 to 2010.Patient samplePatients in the de-identified, risk-adjusted, and multi-institutional ACS NSQIP database undergoing lumbar anterior fusion, posterior fusion, transforaminal lumbar interbody fusion/posterior lumbar interbody fusion (TLIF/PLIF), discectomy, or decompression were included.Outcome measuresPrimary outcome measures were 30-day postsurgical complications, including pulmonary embolism and deep vein thrombosis, death, system-specific complications (wound, pulmonary, urinary, central nervous system, and cardiac), septic complications, and having one or more complications overall. Secondary outcomes were time spent in the operating room, blood transfusions, length of stay, and reoperation within 30 days.MethodsPatients undergoing lumbar anterior fusion, posterior fusion, TLIF/PLIF, discectomy, or decompression in the ACS NSQIP, 2005 to 2010, were categorized into four BMI groups: nonobese (18.5–29.9 kg/m²), Obese I (30–34.9 kg/m²), Obese II (35–39.9 kg/m²), and Obese III (greater than or equal to 40 kg/m²). Obese I to III patients were compared with patients in the nonobese category using chi-square test and analysis of variance. Multivariate linear/logistic regression models were used to adjust for preoperative risk factors.ResultsData were available for 10,387 patients undergoing lumbar surgery. Of these, 4.5% underwent anterior fusion, 17.9% posterior fusion, 6.3% TLIF/PLIF, 40.7% discectomy, and 30.5% decompression. Among all patients, 25.6% were in the Obese I group, 11.5% Obese II, and 6.9% Obese III. On multivariate analysis, Obese I and III had a significantly increased risk of urinary complications, and Obese II and III patients had a significantly increased risk of wound complications. Only Obese III patients, however, had a statistically increased risk of having increased time spent in the operating room, an extended length of stay, pulmonary complications, and having one or more complications (all p<.05).ConclusionsPatients with high BMI appear to have higher complication rates after lumbar surgery than patients who are nonobese. However, the complication rates seem to increase substantially for Obese III patients. These patients have longer times spent in the operating room, extended hospitals stays, and an increased risk for wound, urinary, and pulmonary complications and for having at least one or more complications overall. Surgeons should be aware of the increased risk of multiple complications for patients with BMI greater than or equal to 40 kg/m².     

Can surgical performance benchmarking be generalized across multiple outcomes databases: a comparison of University HealthSystem Consortium and National Surgical Quality Improvement Program

Background

Surgeon's performance is tracked using patient outcomes databases. We compared data on patients undergoing laparoscopic cholecystectomy from 2 large databases with significant institutional overlap to see if either patient characteristics or outcomes were similar enough to accurately compare performance.

Methods

Data from 2009 to 2011 were collected from University HealthSystem Consortium (UHC) and National Surgical Quality Improvement Program (NSQIP). UHC and NSQIP collect data from over 200 and 400 medical centers, respectively, with an overlap of 70. Patient demographics, pre-existing medical conditions, operative details, and outcomes were compared.

Results

Fifty-six thousand one hundred ninety-seven UHC patients and 56,197 NSQIP patients met criteria. Groups were matched by age, sex, and pre-existing comorbidities. Outcomes for NSQIP and UHC differed, including mortality (.20% NSQIP vs .12% UHC; P < .0001), morbidity (2.0% vs 1.5%; P < .0001), wound infection (.07% vs .33%; P < .0001), pneumonia (.38% vs .75%; P < .0001), urinary tract infections (.62% vs .01%; P < .0001), and length of hospital stay (1.8 ± 7.5 vs 3.8 ± 3.7 days; P = .0004), respectively.

Conclusions

Surgical outcomes are significantly different between databases and resulting performance data may be significantly biased. A single unified national database may be required to correct this problem.