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Jason W Busse

Publications and source records attributed to Jason W Busse.

At least 19 recordsLinked to original sources
PubMed2007

Complex limb salvage or early amputation for severe lower-limb injury: a meta-analysis of observational studies.

PURPOSE: Leg threatening injuries present patients and clinicians with a difficult decision: whether to pursue primary amputation or limb salvage? The purpose of our study was to review the literature in an effort to inform this management decision. METHODS: We systematically searched and selected observational studies that reported on individuals presenting with leg threatening injuries comparing outcomes of limb salvage versus primary amputation. We searched MEDLINE, CINAHL, and EMBASE. We reported on the following outcomes, and pooled data across trials when possible: length of hospital stay, total rehabilitation time, cost, clinical outcomes, failure rate for limb salvage, function & quality of life, pain, return to work, factors associated with poor outcome, and patient preference. RESULTS: Nine observational studies contributed data to our systematic review. The current evidence suggests that while length of hospital stay is similar for limb salvage and primary amputation, length of rehabilitation and total costs are higher for limb salvage patients. Salvage patients requires greater additional surgery and are significantly more likely to undergo re-hospitalization. Long-term functional outcomes (up to 7 years post injury) are equivalent between limb salvage and primary amputation; both forms of management are associated with high rates of self-reported disability (40%; to 50%;), and functional status continues to worsen over time. Report of pain following limb salvage or primary amputation is similar. Return to work is essentially the same between limb salvage and primary amputation groups, with approximately half of such patients returning to competitive employment at 2 years post injury. Both clinical and psychosocial factors are associated with poorer functional outcomes. At the time of injury patients prefer limb salvage, but the majority of failed salvage patients would opt for early amputation if they could decide again. CONCLUSION AND SIGNIFICANCE: Functional outcome among patients who present with leg-threatening injuries are not significantly different, at least up to 7 years, whether they are managed with limb salvage or primary amputation. Research to optimize triage decisions to avoid failed limb salvage as well as on interventions targeting important psychosocial prognostic variables should be considered a priority.

Amputation, Surgical↗
PubMed2006

Critical appraisal of the orthopaedic literature: therapeutic and economic analysis.

When reading an article of interest in the orthopaedic literature it is necessary to appraise the quality of the evidence therein. First, the reader should determine the design of the study. If the level of the study design in the hierarchy of evidence is lower, the inferences that are drawn from the study are weaker. Second, the article should be assessed for the quality indicators relevant to the design. To the extent that the quality is high, the inferences that are drawn from the study will be strengthened. Making this process explicit, with guidelines to assess the strength of the available evidence, will serve to improve patient care.

Cohort Studies↗
PubMed2006

Chiropractic services in the Canadian Armed Forces: a pilot project.

This article reports on satisfaction associated with the introduction of chiropractic services within a military hospital, through a Canadian Armed Forces Pilot Project. We distributed a 27-item survey that inquired about demographic information and satisfaction with chiropractic services to 102 military personnel presenting for on-site chiropractic services at the Archie McCallum Hospital in Halifax, Nova Scotia. We provided a second 3-item survey, designed to explore referral patterns and satisfaction with chiropractic services, to all referring military physicians. A multivariable linear regression model was constructed to explore which factors were associated with patients' satisfaction with chiropractic services. The response rate to the patient and physician satisfaction surveys was 67.6% (69 of 102) and 83.3% (10 of 12), respectively. Chronic low back pain accounted for most presentations to the hospital chiropractic clinic. The majority of military personnel (94.2%) and referring physicians (80.0%) expressed satisfaction with chiropractic services. Our adjusted analysis found that older age (beta = -0.37; 95% confidence interval = -0.73 to -0.02) and a presenting complaint of knee pain (beta = -15.56; 95% confidence interval = -29.61 to -1.51) was associated with decreased satisfaction with chiropractic care. Although our finding of high satisfaction with chiropractic services is encouraging, formal studies on functional outcomes and cost effectiveness of chiropractic care are required to better inform the role of chiropractic services in the Canadian Armed Forces.

Adult↗
PubMed2005

The effect of bright light therapy on depression associated with premenstrual dysphoric disorder.

OBJECTIVE: This systematic review summarizes the evidence from randomized clinical trials of bright light therapy for treatment of premenstrual dysphoric disorder. STUDY DESIGN: The authors performed a systematic review and meta-analysis of randomized clinical trials. They searched MEDLINE, AMED, CINAHL, Digital Dissertations, EMBASE, and the Cochrane Central Register of Controlled Trials. The main outcome measure was the change in depressive symptom scores as measured by the Hamilton Depression Rating Scale and the Beck Depression Inventory. RESULTS: Four crossover trials studying a total of 55 participants met inclusion criteria. Three trials showed similar results; one fully unblinded trial showed a much larger effect. The pooled effect size from the random-effects model of the 3 higher quality trials was -0.20 (95% CI -0.48 to 0.07). CONCLUSION: The small size of trials and correspondingly wide confidence limits, and methodologic limitations of the trials, leaves the impact of bright light therapy for relief of premenstrual depressive symptoms uncertain. The current evidence justifies neither enthusiastic dissemination nor confident rejection of this therapeutic modality.

Depression↗
PubMed2005

An economic analysis of management strategies for closed and open grade I tibial shaft fractures.

BACKGROUND: Closed and open grade I (low-energy) tibial shaft fractures are a common and costly event, and the optimal management for such injuries remains uncertain. METHODS: We explored costs associated with treatment of low-energy tibial fractures with either casting, casting with therapeutic ultrasound, or intramedullary nailing (with and without reaming) by use of a decision tree. RESULTS: From a governmental perspective, the mean associated costs were USD 3,400 for operative management by reamed intramedullary nailing, USD 5,000 for operative management by non-reamed intramedullary nailing, USD 5,000 for casting, and USD 5,300 for casting with therapeutic ultrasound. With respect to the financial burden to society, the mean associated costs were USD 12,500 for reamed intramedullary nailing, USD 13,300 for casting with therapeutic ultrasound, USD 15,600 for operative management by non-reamed intramedullary nailing, and USD 17,300 for casting alone. INTERPRETATION: Our analysis suggests that, from an economic standpoint, reamed intramedullary nailing is the treatment of choice for closed and open grade I tibial shaft fractures. Considering financial burden to society, there is preliminary evidence that treatment of low-energy tibial fractures with therapeutic ultrasound and casting may also be an economically sound intervention.

Cost of Illness↗
PubMed2005

Characteristics of pediatric and adolescent patients attending a naturopathic college clinic in Canada.

OBJECTIVES: The use of complementary and alternative medicine (CAM) has grown substantially in North America and has drawn the attention of conventional-medicine practitioners. Conventional-medicine practitioners have expressed concern about the potential for unregulated CAM therapies to cause harm, the sometimes-uncertain cost-benefit ratios associated with these therapies, and the possibility that some CAM providers might advise against established conventional therapies, such as vaccination. These concerns are heightened with respect to the pediatric use of CAM products. To address this issue, we conducted a systematic audit of pediatric and adolescent case files at a large, college-based, Canadian naturopathic teaching clinic. We specifically sought to describe the demographic characteristics, reasons for presentation, use of CAM products, and vaccinations status of children presenting for naturopathic assessment. We also determined factors associated with the use of CAM products and vaccination status. METHODS: We identified all charts for children (<18 years of age) who presented to the Robert Schad Naturopathic Clinic, the teaching clinic of the Canadian College of Naturopathic Medicine, between February 1 and May 31, 2002. Data were abstracted directly from the standardized patient intake forms and from clinical notes recorded during the patient's initial visit to the clinic. The following data were obtained: age, gender, chief presenting complaints reported by parents, CAM product use at presentation, vaccination status, and reactions to vaccination. We conducted logistic regression analyses to identify factors associated with both CAM product use and vaccination status. RESULTS: A total of 482 charts were identified. The mean age of patients was 6.5 years (95% confidence interval [CI]: 1.6-11.4 years). The ratio of female subjects to male subjects was 1.09:1 (248:227). The most common reasons for presentation were skin disorders (23%), gastrointestinal complaints (17%), and psychiatric/behavioral disorders (15%). Thirty-five percent of children were using CAM products at presentation (21.2% when both vitamins and minerals were excluded). Vitamins were the most commonly used products (34.6%), followed by herbal remedies (14.9%), oil blends/fats (7.2%), minerals (5.6%), probiotics (4.5%), and homeopathic remedies (3.7%). Of charts with vaccination information, 8.9% indicated that children had not been vaccinated; possible vaccine-associated adverse events were reported for 27% of those who had been vaccinated. Partial or unvaccinated status was associated with younger age, attending the Canadian College of Naturopathic Medicine for advice regarding vaccination, and greater use of CAM products. CAM product use was associated with unvaccinated or partially vaccinated status (odds ratio [OR]: 2.86; 95% CI: 1.46-5.63), presenting with poor energy or fatigue (OR: 3.36; 95% CI: 1.00-11.26), or presenting with throat or sinus infections (OR: 4.06; 95% CI: 1.23-13.04). CONCLUSIONS: Children present for naturopathic assessment for diverse reasons, are high-level consumers of CAM products, and have lower rates of vaccination than population averages. The conventional-medicine community should work with naturopaths to address public health concerns in this population.

Abdominal Pain↗
PubMed2005

Effect of bisphosphonates on periprosthetic bone mineral density after total joint arthroplasty. A meta-analysis.

BACKGROUND: Periprosthetic bone loss following total joint arthroplasty may threaten the survival of the implant. Bisphosphonates are effective in reducing bone loss in conditions associated with accelerated bone turnover. To determine the current understanding of the effect of bisphosphonates on periprosthetic bone mineral density after total joint arthroplasty, we conducted computerized searches for randomized controlled trials evaluating the use of bisphosphonates in patients treated with primary total joint arthroplasty. METHODS: We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, the web site of the United Kingdom National Research Register, and the archives of the American Academy of Orthopaedic Surgeons annual meetings (1989 through 2003), and we conducted hand searches of the bibliographies of relevant articles. We assessed methodological quality and abstracted relevant data. When necessary, we contacted authors to provide additional information. RESULTS: Of 386 citations that were initially identified, six (five complete papers and one abstract), which included a total of 290 patients, met our inclusion criteria. Those papers showed that significantly less periprosthetic bone loss had occurred in the bisphosphonate-treated patients than in the control patients at three months (152 patients; weighted mean difference, 3.3%; 95% confidence interval, 1.9% to 4.7%; p < 0.01), six months (248 patients; weighted mean difference, 4.5%; 95% confidence interval, 1.6% to 7.4%; p < 0.001), and twelve months (197 patients; weighted mean difference, 4.2%; 95% confidence interval, 1.5% to 6.9%; p = 0.03). Bisphosphonates appeared to have a larger effect on bone loss following arthroplasties with cement than on bone loss following arthroplasties without cement (difference, 0.1%, 5%, and 5.4% at three, six, and twelve months; significant difference [p < 0.001] at one year only) and a larger effect on bone loss following total knee arthroplasties than on bone loss following total hip arthroplasties (difference, 4.1%, 11.5%, and 7.1% at three, six, and twelve months; significant difference [p < 0.001] at six months only). None of the studies related the effects of bisphosphonates on bone mineral density to clinically relevant outcomes. CONCLUSIONS: A meta-analysis of six randomized controlled trials suggested that bisphosphonates have a beneficial effect with regard to maintaining more periprosthetic bone mineral density than that in controls. However, the limitations of the available studies and the lack of analyses of clinically relevant outcomes (functional outcomes, revision rates, and quality of life) necessitate the planning and conduct of a sufficiently sized, methodologically sound study with clinically relevant end points. Until this has been done, the current evidence regarding the beneficial effects of bisphosphonates on periprosthetic bone after total joint arthroplasty should be interpreted with caution.

Arthroplasty, Replacement↗
PubMed2005

Disclosure of natural product use to primary care physicians: a cross-sectional survey of naturopathic clinic attendees.

OBJECTIVE: To determine factors that predict disclosure of natural product use by patients to their primary care physicians. METHODS: An 18-item survey about health care use and communication was distributed to patients who presented to the Canadian College of Naturopathic Medicine in March 2003. We examined correlations between responses and created a multivariable logistic regression model to explore which factors were associated with patients' discussion of natural product use with their primary care physicians. RESULTS: The survey was given to 198 patients, 174 of whom responded (response rate, 87.9%). Most respondents (161 [92.5%] of 174) made use of natural products, and many (61 [41.5%] of 147) reported that they did not discuss natural product use with their primary care physician. The most significant factor predictive of patients having discussed natural product use with their primary care physician was having their primary care physician ask about natural product use (odds ratio, 18.77; 95% confidence interval, 5.06-69.62). Most respondents (107 [69.9%] of 153) indicated that their primary care physician did not ask about natural product use. CONCLUSIONS: An important number of patients who visit a naturopathic clinic do not disclose natural product use to their primary care physicians. Our findings suggest that disclosure rates could be improved by physicians taking a more active role in asking their patients about natural product use.

Adolescent↗
PubMed2004

Association between industry funding and statistically significant pro-industry findings in medical and surgical randomized trials.

BACKGROUND: Conflicting reports exist in the medical literature regarding the association between industry funding and published research findings. In this study, we examine the association between industry funding and the statistical significance of results in recently published medical and surgical trials. METHODS: We examined a consecutive series of 332 randomized trials published between January 1999 and June 2001 in 8 leading surgical journals and 5 medical journals. Each eligible study was independently reviewed for methodological quality using a 21-point index with 5 domains: randomization, outcomes, eligibility criteria, interventions and statistical issues. Our primary analysis included studies that explicitly identified the primary outcome and reported it as statistically significant. For studies that did not explicitly identify a primary outcome, we defined a "positive" study as one with at least 1 statistically significant outcome measure. We used multivariable regression analysis to determine whether there was an association between reported industry funding and trial results, while controlling for study quality and sample size. RESULTS: Among the 332 randomized trials, there were 158 drug trials, 87 surgical trials and 87 trials of other therapies. In 122 (37%) of the trials, authors declared industry funding. An unadjusted analysis of this sample of trials revealed that industry funding was associated with a statistically significant result in favour of the new industry product (odds ratio [OR] 1.9, 95% confidence interval [CI] 1.3-3.5). The association remained significant after adjustment for study quality and sample size (adjusted OR 1.8, 95% CI 1.1-3.0). There was a nonsignificant difference between surgical trials (OR 8.0, 95% CI 1.1-53.2) and drug trials (OR 1.6, 95% CI 1.1-2.8), both of which were likely to have a pro-industry result (relative OR 5.0, 95% CI 0.7-37.5, p = 0.14). INTERPRETATION: Industry-funded trials are more likely to be associated with statistically significant pro-industry findings, both in medical trials and surgical interventions.

Conflict of Interest↗
PubMed2004

Therapeutic ultrasound and fracture healing: a survey of beliefs and practices.

OBJECTIVE: To explore current beliefs among senior physiotherapy (PT) students and orthopedic surgeons on the clinical utility of therapeutic ultrasound for assisting fracture healing. DESIGN: Cross-sectional survey. SETTING: University. PARTICIPANTS: Orthopedic surgeons, senior orthopedic surgery residents, and PT students in their final 6 months of study. INTERVENTIONS: Not applicable. Main outcome measures Percentage of respondents reporting specific perceptions on (1) the role of therapeutic ultrasound in fracture healing, (2) clinical use of therapeutic ultrasound for fracture healing, (3) rationale for not using therapeutic ultrasound for healing fractures, and (4) what constitutes a clinically significant difference in fracture healing time. Between-group comparisons were conducted for survey responses. RESULTS: The response rate was 20 of 22 (90.9%) orthopedic surgeons, 5 of 5 (100%) senior orthopedic residents, and 34 of 50 (68.0%) senior PT students. The majority of senior PT students (58.8%) and orthopedic residents and surgeons (60.0%) surveyed reported the belief that therapeutic ultrasound may help in assisting fracture healing in some cases. However, the majority of respondents do not use this modality (60.0% of surgeons, 88.2% of Senior PT students), with most surgeons (32.0%) citing lack of evidence and most senior PT students (58.8%) indicating lack of availability as the predominant barrier. Thirty-two percent of surgeons felt that ultrasound was contraindicated and harmful to healing fractures, or that it was of no use, and 20.5% of PT students reported the belief that ultrasound was contraindicated and was, or may be, harmful to healing bone. Most orthopedic residents and surgeons (52.0%) reported that a reduction in fracture healing time of 4 weeks would be clinically significant versus senior PT students, the majority of whom (64.7%) indicated that a reduction of 2 weeks would be clinically significant. CONCLUSIONS: Some surgeons and PT students believed that therapeutic ultrasound is contraindicated and harmful to healing bone; however, most believed that therapeutic ultrasound may help in assisting fracture healing, in at least some cases. Current usage of this modality is rare, primarily due to the perceived lack of evidence and lack of availability. Large randomized trials are needed to define further the role of ultrasound in fracture healing.

Attitude of Health Personnel↗
PubMed2004

An observational study found that authors of randomized controlled trials frequently use concealment of randomization and blinding, despite the failure to report these methods.

BACKGROUND AND OBJECTIVE: Readers of randomized controlled trials (RCTs) commonly assume that what was not reported did not occur. We undertook an observational study to determine whether concealment of randomization or blinding was used in RCTs that failed to report these bias-reducing strategies. METHODS: We recorded the reporting of concealment of randomization and blinding in 105 RCTs. We subsequently contacted the authors and determined if they had used these methodological safeguards. RESULTS: We successfully obtained data from 98 authors. The authors in the full-text publications of these 98 RCTs failed to report the presence or absence of concealment of randomization in 55%, and the blinding status of participants in 26%, health care providers in 64%, data collectors in 84%, outcome assessors in 83%, and data analysts in 96%. In direct contact, authors frequently reported concealing randomization (96%; 95% confidence interval CI=87-100%), blinding participants (20%; 95% CI=7-41%), blinding health care providers (65%; 95% CI=52-77%), blinding data collectors (65%; 95% CI=53-75%), blinding outcome assessors (79%; 95% CI=69-87%), and blinding data analysts (50%; 95% CI=40-60%), despite not reporting the use of these methodological safeguards in their publications. CONCLUSIONS: Readers should not assume that bias-reducing procedures not reported in an RCT did not occur.

Bias↗
PubMed2004

The impact of non-injury-related factors on disability secondary to whiplash associated disorder type II: a retrospective file review.

BACKGROUND: There is evidence to suggest that Whiplash Associated Disorders (WADs) are influenced by physical trauma and psychosocial factors, as well as by medicolegal and compensation systems. OBJECTIVE: To investigate the impact of noninjury related variables on self-reported disability at initial assessment among patients presenting with WAD type II injuries. DESIGN AND SETTING: We reviewed a total of 1101 consecutive files of patients presenting to a single chiropractor's office in British Columbia, Canada. We included those who met the inclusion criteria. We extracted demographic variables and noninjury related information from 33 eligible patient files. We calculated correlations between variables and created a multivariable linear regression model to evaluate their relative associations with Neck Disability Index (NDI) scores on presentation. RESULTS: Higher NDI scores on initial assessment correlated with female sex (r = 0.40, P =.02), a greater number of subsequent treatments (r = 0.44, P =.01), a higher number of providers seen before presentation (r = 0.40, P =.02), and most strongly with the involvement of a lawyer (r = 0.73, P <.01). A multivariable linear regression model found that only female sex (P =.03) and the involvement of a lawyer (P =.01) remained significantly associated with higher NDI scores on presentation (adjusted R2 = 0.68 for the model). Female sex was associated with a 10-point increase in NDI scores on presentation (beta coefficient = 10.5; 95% confidence interval [CI] 2.8-18.2), and involvement of a lawyer was associated with a 15-point increase in NDI scores on presentation (beta coefficient = 14.9; 95% CI 5.0-24.7). CONCLUSION: Our analysis of WAD type II patients in receipt of compensation found that higher self-reported disability on initial assessment was associated with female sex and in particular by retaining a lawyer. Large prospective studies are needed to establish the validity of these findings.

Adult↗
PubMed2004

The impact of time of admission on major complications and mortality in patients undergoing emergency trauma surgery.

BACKGROUND: Previous studies have shown a relationship between time of admission to hospital and mortality rates; however, it is uncertain whether such a relationship exists for patients requiring emergency trauma surgery. METHODS: We included all trauma patients, except those with moderate to severe burns, who presented to a university-affiliated level 1 trauma center and underwent surgery, from 1995 until 2001 (n = 1044). We conducted univariate and multivariate analyses in which the dependent variables were in-hospital mortality and major complications, and the independent variables were the time of presentation to the trauma centre (nighttime vs. daytime, weekend vs. weekday, month of year, and year), age, sex, injury severity score, type of operative procedure, and total number of operative procedures. RESULTS: None of the factors related to time of presentation were associated with major complications or mortality. Factors predictive of increased mortality were higher ISS (odds ratio 1.07; 95% confidence interval 1.03-1.08), older age (1.04; 1.03-1.07), operations involving the cardiovascular system (1.7; 1-2.6), "miscellaneous" operative procedures (1.8; 1.1-2.9), and major complications (2.4; 1.4-4.2). INTERPRETATION: Time of presentation for emergency trauma surgery was not associated with differences in major complications or in mortality.

Adolescent↗
PubMed2004

Health-related quality of life following operative treatment of unstable ankle fractures: a prospective observational study.

BACKGROUND: Although Weber type B ankle fractures are often considered benign with a good prognosis, evidence from observational studies suggests that 17% to 24% of such patients may have less satisfactory outcomes. Although the explanation for variability in outcomes remains unclear, previous studies of other surgical procedures have suggested nonsurgery-related causes account for much of the variability in outcomes. METHODS: We conducted a prospective observational cohort study to evaluate health-related quality of life in 30 patients with unstable ankle fractures who were otherwise healthy. Only patients from 2 university-affiliated hospitals sustaining unstable type B Weber injury patterns requiring surgery were eligible. Patients provided detailed baseline information regarding alcohol consumption, smoking habits, and educational level. Patients completed the short form 36 questionnaire and a visual analogue pain scale at regular follow-up intervals. RESULTS: The average patient age was 51.6 years (SD 15.2 years), and 57% (17 out of 30) were male. The majority of fractures were the result of a fall (67%, 20 out of 30), and all were closed injuries. Almost half of all patients were smokers (47%, 14 out of 30), whereas 43% consumed alcohol on a weekly basis (13 out of 30). Forty-three percent of patients (13 out of 30) had obtained an elementary or high school level of education. Patients experienced significant improvements in all domains of the SF-36 questionnaire (P < 0.001), except general health, which remained essentially normal over the 24-month period. Study patients achieved scores similar to age-matched U.S. normative data across 6 of the 8 domains (Role Emotional, Social Function, Mental Health, Bodily Pain, Vitality, and General Health). However, patients' physical function and role physical scores remained significantly lower than US norms at 24 months (21.8 and 20.7 points lower on a 100-point scale, respectively; P < 0.001). Smoking history (P = 0.02), presence of a medial malleolar fracture (P = 0.02), and lower levels of education (P = 0.01) were significant independent predictors of lower physical function up to 3 months postoperation. Lower mental health domain scores were significantly associated with alcohol use (P = 0.02) and increasing age (P = 0.04). CONCLUSIONS: As is the case in many other areas, social factors may be important determinants of outcome in patients with traumatic fractures. Optimal orthopedic care may involve attention to modifiable risk factors, including smoking and alcohol consumption.

Adolescent↗