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Biomedical subjects

Ricardo Pietrobon

Publications and source records attributed to Ricardo Pietrobon.

At least 19 recordsLinked to original sources
PubMed2006

Osteoarthritis and the impact on quality of life health indicators.

The purpose of this study was to compare quality of life health identifiers in patients with and without osteoarthritis (OA) while controlling for the potentially confounding variables of gender, age, race, education, and income. Data were obtained for comparison from the Behavioral Risk Factor Surveillance System (BRFSS) database. Patients with and without OA were analyzed for differences in exercise and activity level, report of physical and mental health, and joint-related symptoms. Over 37,000 individuals were included in the analysis, 6,172 of the participants reported a diagnosis of OA. Participants with a report of OA were more likely to identify problems in all categories except report of mental health. When the potentially confounding variables were controlled, individuals with OA were more likely to report mental health problems. These findings suggest that individuals with OA are more likely to report lower levels of quality of life even while controlling confounding variables.

Adult↗
PubMed2006

DADOS-Prospective: an open source application for Web-based prospective data collection.

BACKGROUND: Randomized, prospective trials involving multi-institutional collaboration have become a central part of clinical and translational research. However, data management and coordination of multi-center studies is a complex process that involves developing systems for data collection and quality control, tracking data queries and resolutions, as well as developing communication procedures. We describe DADOS-Prospective, an open-source Web-based application for collecting and managing prospective data on human subjects for clinical and translational trials. DADOS-Prospective not only permits users to create new clinical research forms (CRF) and supports electronic signatures, but also offers the advantage of containing, in a single environment, raw research data in downloadable spreadsheet format, source documentation and regulatory files stored in PDF format, and audit trails. RESULTS: Feedback from formal and field usability tests was used to guide the design and development of DADOS-Prospective. To date, DADOS-Prospective has been implemented in five prospective clinical studies at our institution. Four of these studies are still in the CRF creation phase and one study has been entirely launched. CONCLUSION: DADOS-Prospective has significant advantages over existing Web-based data collecting programs. At our institution, it has been demonstrated to be an efficient tool for prospective clinical studies.

Journal Article↗
PubMed2006

DADOS-Survey: an open-source application for CHERRIES-compliant Web surveys.

BACKGROUND: The Internet has been increasingly utilized in biomedical research. From online searching for literature to data sharing, the Internet has emerged as a primary means of research for many physicians and scientists. As a result, Web-based surveys have been employed as an alternative to traditional, paper-based surveys. We describe DADOS-Survey, an open-source Web-survey application developed at our institution that, to the best of our knowledge, is the first to be compliant with the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). DADOS-Survey was designed with usability as a priority, allowing investigators to design and execute their own studies with minimal technical difficulties in doing so. RESULTS: To date, DADOS-Survey has been successfully implemented in five Institutional Review Board-approved studies conducted by various departments within our academic center. Each of these studies employed a Web-survey design as their primary methodology. Our initial experience indicates that DADOS-Survey has been used with relative ease by each of the investigators and survey recipients. This has been further demonstrated through formal and field usability testing, during which time suggestions for improvement were incorporated into the software design. CONCLUSION: DADOS-Survey has the potential to have an important role in the future direction of Web-survey administration in biomedical research. This CHERRIES-compliant application is tailored to the emerging requirements of quality data collection in medicine.

Academic Medical Centers↗
PubMed2006

Trends in the epidemiology of total shoulder arthroplasty in the United States from 1990-2000.

OBJECTIVE: Longitudinal trends in epidemiology and utilization of total shoulder arthroplasty (TSA) have not been previously reported. We evaluated trends in the distribution of age, race, hospital volume and teaching status, outcomes, and indications for TSA during the last decade. METHODS: TSA cases (n = 12,758) were extracted from the 1990-2000 Nationwide Inpatient Sample databases. TSA trends were obtained for 3 time periods: 1990-1993 (period I), 1994-1997 (period II), and 1998-2000 (period III). RESULTS: Between 1990 and 2000, there were minor increases in the rate of TSA in most age groups. Ninety-three percent of the patients undergoing TSA in all 3 time periods were white. An increased proportion of patients were operated on in high volume hospitals in period III as compared with period I. Patients discharged to inpatient rehabilitation facilities after surgery had longer lengths of in-hospital stays as compared with those discharged home. Osteoarthritis was diagnosed in an increasing proportion of patients undergoing TSA (56.6% in period I versus 70.9% in period III). CONCLUSION: There was a minor increase in the rate of TSA, and almost no change in use of TSA by nonwhites from 1990 through 2000. Efforts to understand and narrow this apparent underutilization of TSA among nonwhites are required. Further research should determine whether the observed shift of TSA to high volume centers improves surgical outcomes.

Adult↗
PubMed2006

Validation of the NHANES ADL scale in a sample of patients with report of cervical pain: factor analysis, item response theory analysis, and line item validity.

BACKGROUND: Few functional outcomes scales have used Item Response Theory (IRT) for validation. IRT allows individual line item validations and offers substantial advantages over classic methods of scale validation or the simplest from of IRT known as Rasch. Rasch analysis reduces data to dichotomous variables thus decreasing the sensitivity of Likert-type data responses. PURPOSE: The purpose of this study was to create an outcome scale associated with the latent trait of functioning and disability, validated using IRT, in a population with report of cervical pain. METHODS: Using the NHANES database, a recently created scale (NHANES ADL scale) was analysed using factor analysis, internal analyses of consistency, IRT, and comparison with internal measures of functioning and disability. RESULTS: The newly created NHANES ADL scale demonstrated uni-dimensionality, was internally reliable, and was correlated to internal measures of functioning and disability. Additionally, the majority of the scale items demonstrate strong discrimination and suitable thresholds. DISCUSSION: The NHANES ADL scale effectively measures physical, social, and emotional disability in patients with a cervical impairment, and may be an efficient measure of perceived limitations from working and generalized daily physical activity. CONCLUSION: The newly created NHANES ADL scale demonstrates internal consistency, unidimensionality, and line item validity. The NHANES ADL scale appears to be a useful instrument in measurement of functioning and disability in patients with report of cervical pain.

Activities of Daily Living↗
PubMed2006

Duke Surgery Research Central: an open-source Web application for the improvement of compliance with research regulation.

BACKGROUND: Although regulatory compliance in academic research is enforced by law to ensure high quality and safety to participants, its implementation is frequently hindered by cost and logistical barriers. In order to decrease these barriers, we have developed a Web-based application, Duke Surgery Research Central (DSRC), to monitor and streamline the regulatory research process. RESULTS: The main objective of DSRC is to streamline regulatory research processes. The application was built using a combination of paper prototyping for system requirements and Java as the primary language for the application, in conjunction with the Model-View-Controller design model. The researcher interface was designed for simplicity so that it could be used by individuals with different computer literacy levels. Analogously, the administrator interface was designed with functionality as its primary goal. DSRC facilitates the exchange of regulatory documents between researchers and research administrators, allowing for tasks to be tracked and documents to be stored in a Web environment accessible from an Intranet. Usability was evaluated using formal usability tests and field observations. Formal usability results demonstrated that DSRC presented good speed, was easy to learn and use, had a functionality that was easily understandable, and a navigation that was intuitive. Additional features implemented upon request by initial users included: extensive variable categorization (in contrast with data capture using free text), searching capabilities to improve how research administrators could search an extensive number of researcher names, warning messages before critical tasks were performed (such as deleting a task), and confirmatory e-mails for critical tasks (such as completing a regulatory task). CONCLUSION: The current version of DSRC was shown to have excellent overall usability properties in handling research regulatory issues. It is hoped that its release as an open-source application will promote improved and streamlined regulatory processes for individual academic centers as well as larger research networks.

Academic Medical Centers↗
PubMed2006

Cross-cultural adaptation and validation of the Brazilian Portuguese version of the Neck Disability Index and Neck Pain and Disability Scale.

STUDY DESIGN: This study's design was a cross-cultural validation of the Neck Disability Index and Neck Pain and Disability Scale. OBJECTIVES: This study's objective was to translate, culturally adapt, and validate a Brazilian Portuguese version of the Neck Disability Index (NDI-BR) and the Neck Pain and Disability Scale (NPDS-BR). SUMMARY OF BACKGROUND DATA: Although several valid measures exist for measurement of neck pain and functional impairment, these measures have yet been validated in Brazilian Portuguese. Successful linguistic and cultural translation may allow appropriate cross-cultural comparison for clinical and laboratory research analysis. METHODS: The NDI-BR and NPAD-BR were culturally and linguistically translated from English into Brazilian Portuguese. The translated version of the instrument was administered to 203 patients at a midsize hospital in southern Brazil. Psychometric evaluation included factor analysis, internal reliability measures, test-retest reliability at 1 and 7 days, and criterion validity comparison with the Brazilian version of the SF-36. RESULTS: Factor analyses demonstrated a single-factor subscale for the NDI-BR and three subscales for the NPDS-BR. An item analysis showed a high degree of internal consistency for the NDI-BR (r = 0.74) and the three subscales of the NPDS-BR (subscale 1, r = 0.89; subscale 2, r = 0.81; subscale 3, r = 0.72). Test-retest reliability was also acceptable at for the NDI-BR (0.98 at baseline and 0.48 at 7 days) and subset one (0.96 at baseline and 0.91 at 7 days), subset 2 (0.96 at baseline and 0.62 at 7 days), and subset 3 (0.52 at baseline and 0.45 at 7 days) of the NPDS-BR. Construct validity was established during comparison of the Brazilian version of the SF-36. Only items associated with physical role, bodily pain, and emotional role failed significant correlation. CONCLUSIONS: A reliable and valid Portuguese version of the Neck Disability Index and Neck Pain and DisabilityScale was developed, which will facilitate the examination of functional performance within a large patient population, as well as cross-cultural comparisons.

Adult↗
PubMed2006

Chairperson and faculty gender in academic emergency medicine departments.

OBJECTIVES: Despite the influx of female physicians in academic medicine departments, there are a small number of women in faculty and departmental leadership positions in emergency medicine (EM). The objective of this study was to determine if the gender of the chairperson of an academic EM department is associated with the gender of the residency program director (RPD) and gender proportion of its faculty. METHODS: This was a retrospective analysis of 133 academic EM departments using the Society for Academic Emergency Medicine online residency catalog, program Web site, or e-mail. Main outcome measures were proportion of female EM faculty and gender of the RPD. RESULTS: Data were available for 133 academic departments. Women chaired 7.5% (n = 10) of departments and comprised 22.3% of all faculty and 15.0% (n = 20) of RPD positions. EM departments that were chaired by women had a significantly higher percentage of female faculty compared with those led by men (31% vs. 22%; p = 0.01). Similarly, departments that were chaired by women had a significantly higher proportion of female RPDs compared with those chaired by men (50% vs. 12%; p < 0.01). Compared with departments chaired by men, the RPD was 5.0 times (95% confidence interval = 1.9 to 27.8; p < 0.01) more likely to be a woman if the chairperson was also a woman. CONCLUSIONS: An academic EM department was more likely to have a higher proportion of female faculty and a female RPD when the department chairperson was female.

Emergency Medicine↗
PubMed2006

Item analysis of the NHANES ADL instrument in a sample of patients reporting frequent severe headaches.

BACKGROUND AND PURPOSE: The National Health and Nutrition Examination Surveys (NHANES) activity of daily living (ADL) instrument is a 16-item questionnaire designed to represent the internal latent construct of activities of daily living. The purpose of the present study was to measure selected psychometric properties (dimensionality, internal consistency and individual item response) of the NHANES ADL instrument on a population of patients who reported frequent severe headaches. METHOD: The study group consisted of 672 attendees of a traditional medical appointment with a report of severe headaches. Data analyses included exploratory factor analysis, internal consistency measures and graded item response theory. RESULTS: The NHANES ADL instrument is a uni-dimensional and internally consistent measure of activities of daily living. Graded item response theory analyses indicated that all 16 single items were sensitive measures of the latent construct of activities and daily living. Selected items demonstrated high discrimination while others demonstrated moderate discrimination among responses. CONCLUSION: Individual use of selected items of the NHANES ADL instrument may further improve the capacity of the healthcare provider in measuring and recording dysfunction associated with headaches.

Activities of Daily Living↗
PubMed2006

An anatomic study of the cephalic vein in the deltopectoral shoulder approach.

There has been debate regarding medial or lateral retraction of the cephalic vein in the deltopectoral approach to the shoulder. Those who recommend lateral retraction of the vein cite multiple feeder vessels from the deltoid muscle; however, there is little evidence to support this in the orthopaedic literature. The purpose of our study was to determine if there are more lateral branches than medial branches to the cephalic vein in the deltopectoral groove. Forty fresh frozen cadaveric shoulders underwent retrograde latex injection of the cephalic vein. A deltopectoral incision was used, and the numbers of medial and lateral branches were recorded. In the deltopectoral groove there were more lateral than medial feeder vessels to the cephalic vein. There also were more branches to the vein in the proximal (1/2) of the incision compared with the distal (1/2). Most of the specimens dissected had more lateral branches to the cephalic vein than medial branches. Based on the number of feeder vessels to the cephalic vein, results of our study support lateral retraction of the cephalic vein in a majority of shoulders during the deltopectoral approach to the shoulder.

Adult↗
PubMed2006

Metal-on-metal hip resurfacing compares favorably with THA at 2 years followup.

Metal-on-metal total hip resurfacing is a bone-conserving reconstructive option for patients with advanced articular damage. While intended to address several problems with conventional THA, the safety and efficacy is not well established. We therefore retrospectively compared the outcomes of 52 patients (57 hips) with resurfacing arthroplasty to 84 patients (93 hips) with cementless primary THAs. The patients had a minimum 2-year followup (mean 3 years). The patients with resurfacing arthroplasty had a mean age of 47 years (range, 22-64) while those with cementless primary THA had a mean age of 57 years (range, 17-92). After controlling for age, gender, and preoperative differences, the total Harris Hip Scores (HHS), function scores, and pain scores were similar between the two groups. However, the resurfacing group had higher activity scores (14 versus 13, p < 0.001) and range of motion (ROM) scores (5.0 versus 4.8, p < 0.001). The complication rates (5.3% for resurfacing versus 14.0% for THA) and reoperation rates (3.5% for resurfacing versus 4.3% for THA) were similar. The total hip arthroplasty and metal-on-metal resurfacing groups both showed improvement in HHS, pain, activity, and ROM and had similar early complication and reoperation rates.

Adolescent↗
PubMed2006

Comprehensive morphologic evaluation of the hip in patients with symptomatic labral tear.

A torn acetabular labrum is a well-documented source of hip pain, but the mechanism of injury is debated because the relationship between the bone morphology and labral tears is poorly understood. We compared hips with and without labral abnormalities to determine the relative incidence of morphologic abnormalities. The study group consisted of patients with a labral tear confirmed by arthroscopy or arthrotomy at the time of open débridement or periacetabular osteotomy. We compared the affected hip with the contralateral, unaffected hip to ascertain signs of hip dysplasia and impingement. We observed differences in the center edge angle, acetabular depth to width index, acetabular index of elevation, femoral head extrusion, lateral and superior subluxation, Sharp's angle, peak to edge distance, and acetabular retroversion. Similar differences occurred in the subgroup analyses. Symptomatic labral tears correlated with abnormal hip morphology as reflected by radiographic measurements of dysplasia and impingement. This relationship occurred in patients with hip dysplasia and patients without obvious femoral head uncovering. Our findings suggest abnormal hip morphology may be a risk factor for labral tears.

Acetabulum↗
PubMed2006

Validation of a Spanish version of the Short Musculoskeletal Function Assessment Questionnaire (SMFA).

OBJECTIVES: The purpose of this study was to develop a linguistically appropriate, culturally adapted, and appropriately validated Spanish version of the SMFA (SMFA-Mex). DESIGN: Validation of a survey-based outcome instrument. SETTING: Busy state hospital in southern Mexico. PATIENTS/PARTICIPANTS: Consecutive trauma patients with a variety of orthopedic disorders. INTERVENTION: N/A. MAIN OUTCOME MEASUREMENTS: The SMFA-Mex was forward and back translated, administered to orthopedic trauma patients, and compared against the Spanish version of the SF-36s for criterion validity. Statistical analysis included factor analysis, criterion validation with the SF-36, and internal measures of reliability. RESULTS: Factor analysis demonstrated three separate subscale dimensions: 1) upper-extremity dysfunction, 2) lower-extremity dysfunction, and 3) lifestyle alterations. Item analysis showed a high degree of internal consistency for the three subscales (subscale 1, r = 0.95; subscale 2, r = 0.94; subscale 3, r = 0.92). Test-retest reliability at 7 days was 0.93 for the upper-extremity dysfunction subscale, 0.95 for the lower-extremity dysfunction subscale, and 0.92 for the lifestyle-alterations subscale. Construct validity was established by comparison of the Brazilian version of the SF-36. CONCLUSIONS: The SMFA-Mex was successfully translated and culturally adapted from the English original. The SMFA-Mex demonstrated adequate scale reliability and validity and yielded three distinct subscales using factor analysis.

Adolescent↗
PubMed2006

The effect of age on sciatic nerve block duration.

The physiologic changes that occur with advancing age and their effect on the duration of peripheral nerve blocks have yet to be defined. We prospectively studied the duration of sciatic nerve block using mepivacaine in younger and older patients. Eighty ASA physical status I-III patients, aged 18-35 (n = 40) or 55-80 (n = 40) yr, having outpatient knee arthroscopy with a femoral block and a standardized sciatic nerve block were enrolled; 37 in each group completed the study. All patients received a Labat sciatic nerve block using 20 mL of 1.0% mepivacaine with 0.1 mEq/mL sodium bicarbonate and 1:400,000 (2.5 microg/mL) epinephrine and a femoral nerve block. The duration of sensory block (sensation of pinprick, temperature, and vibration), motor block (plantar and dorsi flexion), and complete sensory and motor block in the sciatic nerve distribution of the operative extremity were measured. The time for complete return of both sensory and motor function was longer in the older group, 329 +/- 47 min compared with 306 +/- 46 min (mean +/- sd) in the younger group (P = 0.04). The difference was small under the conditions of this study and would not be perceived clinically. Age also increased the time to return of vibratory sensation (younger = 292 +/- 58 min, older = 257 +/- 50 min; P = 0.007). The other measurements did not differ between groups. We conclude that age may affect peripheral nerve blocks and that more investigation is needed to determine the pharmacologic, physiologic, and chronologic factors behind these findings.

Adolescent↗
PubMed2006

Influence of acetabular coverage on hip survival after free vascularized fibular grafting for femoral head osteonecrosis.

BACKGROUND: Osteonecrosis of the femoral head frequently results in collapse of the head and subsequent arthrosis of the joint. Surgical treatment has been based entirely on the evaluation of the femoral side of the hip joint, with little consideration given to the possible influence on outcome of the orientation of the acetabulum. METHODS: We retrospectively reviewed a consecutive series of 200 hips in 160 patients with osteonecrosis of the femoral head who had undergone free vascularized fibular grafting between 1997 and 1998. The mean duration of clinical follow-up was 7.5 years. Ninety-one hips in seventy-one patients were evaluated radiographically for evidence of progression of femoral head collapse at a minimum of two years, and a mean of three years, postoperatively. We defined conversion to a total hip arthroplasty and progression of femoral head collapse as the failure end points, and we analyzed the association of the acetabular center-edge angle of Wiberg, the area and laterality of the lesion, the amount of preoperative collapse of the femoral head, and the etiology of the osteonecrosis with the likelihood of failure. RESULTS: Forty-eight (24%) of the 200 hips had undergone conversion to a total hip arthroplasty at the time of the final clinical follow-up. In addition, 15% (fourteen) of the ninety-one hips with sufficient radiographic follow-up demonstrated progression of femoral head collapse at the time of the final radiographic examination. Of the hips with a center-edge angle of </=30 degrees , 55% (of those with sufficient radiographic follow-up) demonstrated progressive collapse and 45% were converted to a total hip arthroplasty. In contrast, of the hips with a center-edge angle of >30 degrees , 10% had progressive collapse (p = 0.002) and 6% were converted to a total hip arthroplasty (p < 0.001). Neither the etiology nor the size of the lesion was significantly correlated with progression of collapse or conversion to a total hip arthroplasty. CONCLUSIONS: Patients with osteonecrosis of the femoral head and a suboptimal center-edge angle of the hip are at substantial risk for progression of femoral head collapse and conversion to a total hip arthroplasty following free vascularized fibular grafting. An estimation of the degree of hip dysplasia should be included in the preoperative assessment of patients with osteonecrosis of the femoral head for prognostic and possibly surgical planning purposes.

Acetabulum↗
PubMed2005

Manuscript Architect: a Web application for scientific writing in virtual interdisciplinary groups.

BACKGROUND: Although scientific writing plays a central role in the communication of clinical research findings and consumes a significant amount of time from clinical researchers, few Web applications have been designed to systematically improve the writing process. This application had as its main objective the separation of the multiple tasks associated with scientific writing into smaller components. It was also aimed at providing a mechanism where sections of the manuscript (text blocks) could be assigned to different specialists. Manuscript Architect was built using Java language in conjunction with the classic lifecycle development method. The interface was designed for simplicity and economy of movements. Manuscripts are divided into multiple text blocks that can be assigned to different co-authors by the first author. Each text block contains notes to guide co-authors regarding the central focus of each text block, previous examples, and an additional field for translation when the initial text is written in a language different from the one used by the target journal. Usability was evaluated using formal usability tests and field observations. RESULTS: The application presented excellent usability and integration with the regular writing habits of experienced researchers. Workshops were developed to train novice researchers, presenting an accelerated learning curve. The application has been used in over 20 different scientific articles and grant proposals. CONCLUSION: The current version of Manuscript Architect has proven to be very useful in the writing of multiple scientific texts, suggesting that virtual writing by interdisciplinary groups is an effective manner of scientific writing when interdisciplinary work is required.

Authorship↗
PubMed2005

Trends in epidemiology of knee arthroplasty in the United States, 1990-2000.

OBJECTIVE: There is little information on longitudinal trends in the epidemiology of total knee arthroplasty (TKA). This study was undertaken to determine whether, during the past decade, TKA rates increased in younger adults and older adults, whether utilization of TKA increased among minorities, and whether more patients underwent surgery at high-volume hospitals. METHODS: TKA cases (n = 443,008) were extracted from the 1990-2000 Nationwide Inpatient Sample database. TKA trends for 3 time periods were obtained (1990-1993 [period I], 1994-1997 [period II], and 1998-2000 [period III]). RESULTS: Between period I and period III, the proportion of TKAs performed increased by 95.2% in the 40-49-year age group and by 53.7% in the 50-59-year age group. Black patients and Hispanic patients were more likely to undergo TKA in period III than in period I (odds ratio [OR] = 1.6, 95% confidence interval [95% CI] 1.5-1.6 and OR 2.7, 95% CI 2.5-2.9, respectively). However, white patients accounted for 93.0%, 89.9%, and 87.5% of TKAs in the 3 time periods, respectively. In period III, the proportion of patients undergoing surgery in high-volume hospitals increased compared with periods I and II. Both mortality and length of hospital stay diminished significantly in period III, but the rate of discharge to an inpatient facility increased by 89.7% (period I to period III). CONCLUSION: Over the past decade, TKA was increasingly performed in younger patients, which suggests a broadening of indications for this procedure. Although utilization of TKA increased among minorities, the vast majority of TKAs were performed in white patients. Further efforts to narrow this disparity are required. The shift toward TKAs being increasingly performed at high-volume centers may improve surgical outcomes. Finally, the effect of increased discharge to inpatient facilities on TKA outcomes needs to be ascertained.

Adult↗