Bulletin of the NYU hospital for joint diseases
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The p-value is a widely used tool for inference in clinical studies. However, despite the numerous books and papers published on the basics of statistical inference and, thus, on the p-value, there still seems to be a need to highlight what message the p-value exactly contains (and what it does not). In this article, the basic concepts and the different misconceptions regarding the p-value will be highlighted and illustrated with a clinical trial in osteoarthritis. It will also be shown that the (95%) confidence interval is to be preferred over the p-value as a statistical inference tool.
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Bull NYU Hosp Jt Dis · Jan 2008
ReviewOrthopaedic anesthesia - part 2. Common techniques of regional anesthesia in orthopaedics.
Anesthesia may be considered in terms of two categories: general and regional. The aim of general anesthesia is to induce analgesia, sedation, amnesia, suppression of autonomic reflexes, and relaxation of muscles. ⋯ Although neuraxial blocks comprise an important part of regional anesthesia, they are typically performed by anesthesiologists in an operative setting for major procedures of the lower extremities. The intent of this article is to familiarize the orthopaedist with techniques that have implications for emergency rooms and other ambulatory settings in which regional techniques are sometimes favored over general alternatives because they entail less risk of systemic side effects and may involve more cost-effective use of resources.
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Bull NYU Hosp Jt Dis · Jan 2008
ReviewOrthopaedic anesthesia - part 1. Commonly used anesthetic agents in orthopaedics.
Anesthesia is a broad discipline; for orthopaedic applications, the type and location of the planned orthopaedic procedure is important in the selection of the most appropriate anesthetic agent and technique. The purpose of this overview is to: 1. highlight the role of several anesthetic agents commonly used in an orthopaedic setting and 2. to familiarize the orthopaedist with those techniques of regional anesthesia that have implications for emergency rooms and other ambulatory settings. Because the subject matter is expansive in scope, it is necessary to address each of the above objectives separately, in two different articles. Part 1 describes anesthetic agents, whereas Part 2 encompasses techniques of administering regional anesthesia.
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Bull NYU Hosp Jt Dis · Jan 2008
Some concerns about adverse event reporting in randomized clinical trials.
Reporting of adverse events (AEs) in randomized clinical trials (RCTs) is often lacking and with limited application in the real world, as RCTs are of short duration, include small numbers of patients, and are selective for subjects lacking in comorbid conditions. It is not surprising that new and unexpected safety concerns emerge with any new drug after it has been launched and used by many more patients. ⋯ This article focuses on some of the shortcomings of AE reporting in RCTs, especially those involving tumor necrosis factor (TNF) inhibitors. Discussion focuses on reporting of "time-to-event" issues, use of standardized incidence ratios for comparison to normal population or disease controls, use of "patient-years" when reporting AEs, and the problem of adequate sample size and power calculations that are lacking in safety outcome data trials.
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Bull NYU Hosp Jt Dis · Jan 2008
Predictors of mortality after hip fracture: a 10-year prospective study.
The role of medical, social, and functional covariates on mortality after hip fracture was examined over a 16-year period. A total of 1109 patients with hip fractures were included in a prospective database. The inclusion criteria were patients who were age 65 years or older, ambulatory prior to fracture, cognitively intact, living in their own home at the time of the fracture, and had sustained a nonpathological femoral neck or intertrochanteric chip fracture. ⋯ The predictors of mortality were advanced age, male gender, high American Society of Anesthesiologists (ASA)classification, the presence of a major postoperative complication, a history of cancer, chronic obstructive pulmonary disorder, a history of congestive heart failure,ambulating with an assistive device, or being a household ambulator prior to hip fracture. The increased mortality risk was highest during the first year after hip fracture and returned to the risk of the standard population 3 years postoperatively. Males who are 65 to 84 years had the highest mortality risk.