Biomedical subjects

Laurent Audige

Publications and source records attributed to Laurent Audige.

4 recordsLinked to original sources

PubMed2004

The need for education in evidence-based orthopedics: an international survey of AO course participants.

BACKGROUND: As evidence-based practitioners, surgeons need to understand study methodology to critically appraise and conduct research. OBJECTIVE: To determine current understanding of study methodology and critical appraisal among participants at an international educational meeting. METHODS: We surveyed participants attending the 76th and 77th AO Course (December 2002) in Davos, Switzerland. We obtained information regarding participant age, gender, clinical and research experience, subspecialty area and respondents' roles in the AO course. The survey questions were formatted into three areas: evidence-based orthopedics, randomization and blinding issues. RESULTS: 532 participants completed the questionnaire. They represented 78 countries, the majority of which (31%) were from German-speaking countries. A greater proportion of participants trusted randomized controlled trials (89%) and meta-analyses of randomized trials (81%) when compared with case series and case reports. 60 respondents (11%) had never heard of the term "randomization" as a study design method to limit bias, and 114 respondents (21%) had never heard of the term "blinding" as a method of reducing bias in surgical research. When those who had heard of blinding were asked to define the term "double-blind", 20 different definitions resulted. Having completed the survey, nine-tenths of the respondents endorsed the need for training of surgeons in research methodology.

Adult↗

PubMed2003

Hierarchy of evidence: differences in results between non-randomized studies and randomized trials in patients with femoral neck fractures.

INTRODUCTION: There have been a number of non-randomized studies comparing arthroplasty with internal fixation in patients with femoral neck fractures. However, there remains considerable debate about whether the results of non-randomized studies are consistent with the results of randomized, controlled trials. Given the economic burden of hip fractures, it remains essential to identify therapies to improve outcomes; however, whether data from non-randomized studies of an intervention should be used to guide patient care remains unclear. We aimed to determine whether the pooled results of mortality and revision surgery among non-randomized studies were similar to those of randomized trials in studies comparing arthroplasty with internal fixation in patients with femoral neck fractures. MATERIALS AND METHODS: We conducted a Medline search from 1969 to June 2002, identifying both randomized and non-randomized studies comparing internal fixation with arthroplasty in patients with femoral neck fractures. Additional strategies to identify relevant articles included Cochrane database, SCISEARCH, textbooks, annual meeting programs, and content experts. We abstracted information on mortality and revision rates in each study and compared the pooled results between non-randomized and randomized studies. In addition, we explored potential reasons for dissimilar results between the two study designs. RESULTS: We identified 140 citations that addressed the general topic of comparison of arthroplasty and internal fixation for hip fracture. Of these, 27 studies met the eligibility criteria, 13 of which were non-randomized studies and 14 of which were randomized trials. Mortality data was available in all 13 non-randomized studies ( n=3108 patients) and in 12 randomized studies ( n=1767 patients). Non-randomized studies overestimated the risk of mortality by 40% when compared with the results of randomized trials (relative risk 1.44 vs 1.04, respectively). Information on revision risk was available in 9 non-randomized studies ( n=2764 patients) and all 14 randomized studies ( n=1901 patients). Both estimates from non-randomized and randomized studies revealed a significant reduction in the risk of revision surgery with arthroplasty compared with internal fixation (relative risk 0.38 vs 0.23, respectively). The reduction in the risk of revision surgery with arthroplasty compared with internal fixation was 62% for non-randomized studies and 77% for randomized trials. Thus, non-randomized studies underestimated the relative benefit of arthroplasty by 19.5%. Non-randomized studies with point estimates of relative risk similar to the pooled estimate for randomized trials all controlled for patient age, gender, and fracture displacement in their comparisons of mortality. We were unable to identify reasons for differences in the revision rate results between the study designs. CONCLUSIONS: Similar to other reports in medical subspecialties, non-randomized studies provided results dissimilar to randomized trials of arthroplasty vs internal fixation for mortality and revision rates in patients with femoral neck fractures. Investigators should be aware of these discrepancies when evaluating the merits of alternative surgical interventions, especially when both randomized trials and non-randomized comparative studies are available.

Arthroplasty, Replacement, Hip↗

PubMed2003

Operative treatment of extra-articular proximal tibial fractures.

BACKGROUND: Extra-articular proximal tibial fractures are often the result of high-energy trauma with displacement and comminution. Most authors agree that operative management of these fractures is warranted to optimize patient outcomes. It is unclear, however, which surgical option (plate, nail, external fixator, or combination) is preferable. (1-17) OBJECTIVE: To evaluate the effect of alternative operative techniques in the management of extra-articular proximal third tibial fractures on rates of nonunion, malunion, infection, compartment syndrome, and implant failure. HIGHEST AVAILABLE EVIDENCE: 1. Intramedullary nail (level 3 prospective case series). 2. Plates (level 3 prospective case series). 3. External fixator (level 4 case series). STUDY IDENTIFICATION: 1. Cochrane Database: 0 articles. 2. PubMed Search: Proximal tibial fractures: 568 hits; And external fixation: 69 hits; And plate: 103 hits; And intramedullary nail: 77 hits. Clinical queries search: proximal tibial fracture (specificity/therapy): 1 hit; proximal tibial fracture (sensitivity): 24 hits. Systematic reviews: 3 hits (none relevant). 3. OTA website abstract database: 8 abstracts. Total number potentially relevant articles: 29 (following review of all study titles and abstracts). Total number included after review: 17 (1-17) .

Evidence-Based Medicine↗

PubMed2003

Common statistical methods in orthopaedic clinical studies.

We discuss the statistical representation and management of random error in orthopaedic clinical studies. Descriptive studies (such as case series) collect information about a sample that may be generalized to describe a population. Typically this description is in the form of summary statistics, such as means, proportions, or rates. Error in these variables may be represented by confidence intervals. Correlation and regression are techniques for investigation of the relationship between two or more variables. Descriptive statistics, comparisons of groups, especially hypothesis tests, and assessment of association including correlation and regression are important statistical concepts for clinicians involved in the conduct or appraisal of orthopaedic clinical research.

Chi-Square Distribution↗