Nasir Hussain

A Comparison of the Types of Screening Tool Administration Methods Used for the Detection of Intimate Partner Violence A Systematic Review and Meta-Analysis

Intimate partner violence (IPV) is associated with significant health consequences for victims, including acute/chronic pain, depression, trauma, suicide, death, as well as physical, emotional, and mental harms for families and children. The objective of this systematic review and meta-analysis was to assess the rate of IPV disclosure in adult women (>18 years of age) with the use of three different screening tool administration methods: computer-assisted self-administered screen, self-administered written screen, and face-to-face interview screen. A comprehensive literature search was conducted in the MEDLINE, EMBASE, PsycINFO, CINAHL, Database of Abstracts of Reviews of Effectiveness, and the Cochrane library databases. We identified 746 potentially relevant articles; however, only 6 were randomized controlled trials (RCTs) and included for analysis. No significant differences were observed when women were screened in face-to-face interviews or with a self-administered written screen (Odds of disclosing: 1.02, 95% confidence interval [CI]: [0.77, 1.35]); however, a computer-assisted self-administered screen was found to increase the odds of IPV disclosure by 37% in comparison to a face-to-face interview screen (odds ratio: 0.63, 95% CI: [0.31, 1.30]). Disclosure of IPV was also 23% higher for computer-assisted self-administered screen in comparison to self-administered written screen (Odds of disclosure: 1.23, 95% CI: [0.0.92, 1.64]). The results of this review suggest that computer-assisted self-administered screens leads to higher rates of IPV disclosure in comparison to both face-to-face interview and self-administered written screens.

Adductor Canal Block Versus Femoral Canal Block for Total Knee Arthroplasty: A Meta-Analysis: What Does the Evidence Suggest?

Due to the invasiveness of total knee arthroplasty (TKA), the procedure is often associated with extreme postoperative pain. In fact, 23% of patients cite at home pain as “severe/ extreme” after surgery, whereas 54% of the patients indicate “severe pain at least some of the time.”Moreover, it has been suggested that postoperative pain can also interfere with the recovery process, which can put patients at an increased risk for postoperative complications including infections, loosening of the joint, and reflex sympathetic dystrophy. Different techniques can be used preoperatively to complement the effects of general anesthesia, including femoral nerve block (FNB) and adductor canal block (ACB)/saphenous nerve block. Femoral nerve block has traditionally been an efficient method to reduce postoperative pain after TKA. For instance, Chan et al found that FNB decreased pain scores at 24 hours as comparedwith a sham procedure. Moreover, Jadon et al observed that FNB is a more efficient method of analgesia as compared with IV fentanyl. However, FNB has been found to have postsurgical complications, including severe quadriceps muscle weakness. Certainly, surgical causes such as tourniquet-related weakness or surgical quadriceps dysfunction must also be considered, but femoral nerve blockade– related weakness can be explained by the anatomy of the nerve targeted in the FNB. The femoral nerve not only comprises sensory branches, but also contains motor branches that innervate muscles of the upper and lower leg. The motor nerve involvement of the FNB is what leads to muscle weakness, which can alter the ability of the patient to ambulate properly and can increase the risk of postoperative falls. As such, ACB is a method of analgesia that has recently sparked tremendous interest in the scientific community due to its potential benefits over FNB; however, this approach itself does not come without controversy. Adductor canal block is thought to be as effective as FNB in reducing postoperative pain. In addition to having similar pain scores reported by patients, ACB has been thought to be

The influence of large clinical trials in orthopedic trauma: do they change practice?

Objectives: To evaluate the influence of top fracture trials on the practice of orthopedic surgeons. Design: This is a cross-sectional study. Participants: We electronically administered the survey to all members of the Canadian Orthopedic Association. We received responses for 222 surveys, of which, 178 surveys were completed. Intervention: We distributed a survey that evaluated the influence of 7 important fracture studies (6 randomized controlled trials and 1 prospective cohort study) on practice, patient care and the overall advancement of knowledge in the field of orthopedics. This study was approved by our local ethics review board. Main outcome measure: The primary outcome measure was the perceived general influence and impact of important fracture studies on the perceptions and practice of orthopedic surgeons. Results: The Clavicular Fixation Trial (2007) and Tibial Fracture Trial (SPRINT, 2008) were perceived by surgeons to have the greatest influence on advancing overall knowledge in the field, improving personal practice, and the most influence on improving patient care. On the other hand, the Bone Stimulation in Fractures Trial (2011) and the recombinant human bone morphogenetic protein-2-BESST Trial (2002) had the lowest mean influence ranks. The probability of changing practice was significantly higher (Odds Ratio, 2.89; 95% confidence interval, 2.16–3.88; P < 0.00001) when studies had positive outcomes in comparison with negative outcomes. Conclusions: Despite the complexity and costs associated with clinical trials in orthopedic trauma, the results from this survey suggest that these studies result in a demonstrable perceived influence and impact on the practice of orthopedic surgeons.

Intramedullary Nailing Versus Plate Fixation for the Treatment Displaced Midshaft Clavicular Fractures: A Systematic Review and Meta-Analysis.

The two commonly performed surgical techniques used to repair displaced midshaft clavicle fractures are plate fixation or intramedullary nailing; however, despite recent evidence, the optimal method to treat such fractures remains a continued topic of debate. A meta-analysis of randomized controlled trials (RCTs) was conducted to evaluate long term function, complications, and operative duration in adult patients receiving intramedullary nailing in comparison to plating. Seven RCTs and three quasi-randomized trials were included. No significant difference was found in long-term function between the two groups (MD: −0.66, 95% CI: −2.03 to 0.71, I2 = 62%, p = 0.34). Patients who received plating had a 2.19 times increased risk of treatment failure, but this failed to reach significance (95% CI: 0.93 to 5.15, I2 = 0%, p = 0.07). The risk of non-operative complications was 2.11 times higher in patients who received plating and this reached statistical significance (95% CI: 1.38 to 3.23, I2 = 53%, p = 0.0006). Finally, plating significantly prolonged operative duration by 20.16 minutes (95% CI: 16.87 to 23.44, I2 = 56%, p < 0.00001). Our results suggest that intramedullary nailing and plating provide equivalent long-term functional outcomes; however, plating may lead to a higher risk of treatment failure and non-operative complications.

The 3-min appraisal of a meta-analysis

Meta-analysis can be defined as a quantitative method that mathematically combines the results from multiple studies covering the same overall topic, or the statistical pooling of the results of two or more similar studies.1,2 The results from meta-analyses can vary depending on the quality of the studies included and the methodological rigor used to select studies.2 We provide quick and simple criteria for critical appraisal, and a practical example illustrates the approach.

Should thoracic paravertebral blocks be used to prevent chronic postsurgical pain after breast cancer surgery? A systematic analysis of evidence in light of IMMPACT recommendations

Abstract The role of thoracic paravertebral block (PVB) in preventing chronic postsurgical pain (CPSP) after breast cancer surgery (BCS) has gained interest, but existing evidence is conflicting, and its methodological quality is unclear. This meta-analysis evaluates efficacy of PVB, compared with Control group, in preventing CPSP after BCS, in light of the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) recommendations. Electronic databases were searched for randomized trials comparing PVB with Control group for CPSP prevention after BCS. Eligible trials were assessed for adherence to IMMPACT recommendations. The primary outcomes were CPSP at 3 and 6 months, whereas secondary outcomes were PVB-related complications. Data were pooled and analyzed using random-effects modelling. Trial sequential analysis was used to evaluate evidence conclusiveness. Data from 9 studies (604 patients) were analyzed. The median (range) of IMMPACT recommendations met in these trials was 9 (5, 15) of 21. Paravertebral block was not different from Control group in preventing CPSP at 3 months, but was protective at 6 months, with relative risk reduction (95% confidence interval) of 54% (0.24-0.88) (P = 0.02). Meta-regression suggested that the relative risk of CPSP was lower when single-injection (R2 = 1.00, P < 0.001) and multilevel (R2 = 0.71, P = 0.01) PVB were used. Trial sequential analysis revealed that 6-month analysis was underpowered by at least 312 patients. Evidence quality was moderate according to the GRADE system. Evidence suggests that multilevel single-injection PVB may be protective against CPSP at 6 months after BCS, but methodological limitations are present. Larger trials observing IMMPACT recommendations are needed to confirm this treatment effect and its magnitude.

Appropriate Discourse: Reply to Drs Smith and Barrington.

To the Editor: In the interest of improved reporting of systematic reviews and meta-analyses in future issues of this journal, we are compelled to comment on the recent report by Hussain et al of a meta-analysis of 6 randomized controlled trials comparing adductor canal to femoral nerve blockade for total knee arthroplasty. A meta-analysis provides a means by which to aggregate information from multiple clinical studies leading to increased statistical power and a more robust point estimate compared with a measure derived from an individual study. The quality of the meta-analysis performed is dependent on the scope and quality of the studies sourced, as well as the analysis type performed, which should take into account confounding factors such as risk of bias. It is for this reason that the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement and subsequent guidelines were developed. PRISMA set out an evidencebased minimum set of items for reporting in systematic reviews and meta-analyses, providing an assessment instrument that