Checklist Protocol Research Articles

Contributions of the Communication and Management of Bad News in Nursing to the Readaptation Process in Palliative Care: A Scoping Review

Background: Delivering bad news is a sensitive and challenging aspect of nursing healthcare, requiring a holistic approach that respects patients’ preferences, cultural values, and religious beliefs to promote adaptation to the person’s state of health. Aim: We aim to map the evidence of the dimensions present in the communication and management of bad news by nurses to a person in a palliative situation, their caregivers, and their family members. Methods: Based on the Joanna Briggs Institute methodology, the search was conducted through MEDLINE Complete (EBSCOhost), CINAHL Complete (EBSCOhost), SciELO, and the Open Access Scientific Repository in Portugal. From a total of 756 articles, 14 were included, published between 2018 and 2023. Results: Structure components in bad news are influenced by the characteristics of the palliative patients, their caregivers, their family members, the nurses, and the organizational environment. Promoting the quality of the communication process is desirable through continuous and advanced training in end-of-life care, training in bad news, religiously and culturally sensitive nursing interventions centered on hope and maintaining faith, emotional management, and the utilization of a checklist protocol. Conclusions: Honest communication allows people to actively participate in the decision-making process and in the trajectory of the care plan that is focused on themselves and their preferences, which has outcomes in functional capacities and readaptation.

Use of Postpartum Hemorrhage Checklist during Vaginal Deliveries: A Quality Improvement Study.

Postpartum hemorrhage (PPH) protocols improve patient safety and reduce utilization of blood products; however, few data exist on sustainability of PPH checklist use, how use affects care delivery, and variation of use among patient subgroups. This study aimed to (1) examine compliance with PPH checklist use during vaginal deliveries, (2) evaluate whether checklist use varied by patient and/or care team characteristics, and (3) evaluate whether checklist use was associated with increased use of recommended medications/interventions. This was a quality improvement study performed from April 2021 through June 2023. A multidisciplinary team developed a revised PPH checklist and used quality improvement methodology to increase checklist use following vaginal birth. Data were collected from medical records and clinician survey. Control charts were generated to track checklist use and evaluate special cause variation. Chi-square tests and logistic regression were used to evaluate variation in medications/interventions and across subgroups. During the study period, there were 342 cases of PPH at the time of vaginal birth. The checklist was used in 67% of PPH cases during the 20-month period after implementation in a setting where no checklist was previously being used. We found no statistically significant differences in checklist use by patient or health care team characteristics. Use of tranexamic acid, carboprost, and misoprostol were significantly associated with checklist use. This study demonstrated successful implementation of a checklist protocol where no checklist was previously being used, with sustained use in an average of 67% of PPH cases over 20 months. Checklist use was consistent across subgroups and was associated with higher use of interventions shown to lower blood loss. · Our study showed sustainability of PPH checklist use over a 20-month period.. · PPH checklist use was associated with increased use of interventions known to reduce blood loss.. · Checklist was used consistently across patient subgroups; may help address inequities in obstetric outcomes..

Learning Landscape in Gamification: The Need for a Methodological Protocol in Research Applications.

In education, the term "gamification" refers to of the use of game-design elements and gaming experiences in the learning processes to enhance learners' motivation and engagement. Despite researchers' efforts to evaluate the impact of gamification in educational settings, several methodological drawbacks are still present. Indeed, the number of studies with high methodological rigor is reduced and, consequently, so are the reliability of results. In this work, we identified the key concepts explaining the methodological issues in the use of gamification in learning and education, and we exploited the controverses identified in the extant literature. Our final goal was to set up a checklist protocol that will facilitate the design of more rigorous studies in the gamified-learning framework. The checklist suggests potential moderators explaining the link between gamification, learning, and education identified by recent reviews, systematic reviews, and meta-analyses: study design, theory foundations, personalization, motivation and engagement, game elements, game design, and learning outcomes.

Improving Wake-Up Times for Spine Surgery Using New OR Team Checklist Protocol and Communication

Introduction: Prolonged post-anesthesia wake-up times present a threat to patient safety. Shorter wake-up times allow for intraoperative physical exams and potential to re-operate quickly in case of detected neurologic deficits, which may allow for a better neurologic outcome. Furthermore, shorter wake-ups may reduce length of hospital stay, lowering healthcare costs. Methods: We studied how a standardized spine deformity surgery checklist and new OR team communication impacted post-anesthesia wake-up times after scoliosis surgery. We used a Kruskal-Wallis one-way ANOVA to compare 17 wake-up times recorded prior to using the new surgery checklist and teamwork protocol to 468 wake-up times recorded over three years after implementation of the new protocol. We used a Pearson correlation coefficient to analyze how wake-up times varied based on surgical duration with the new protocol. Results: After one year of the new protocol, wake-up times reduced from an average of 16.6 minutes to an average of 7.6 minutes. Wake-up times further declined to an average of 6.0 minutes by years two and three of the new protocol, with significant reductions in these years (p=0.024 and p=0.030, respectively). Improvements to the protocol were made over time in response to outliers. Nearly 75% of wake-up times were less than five minutes with the new protocol. Wake-up times recorded using the new protocol showed a significant weak positive correlation with surgical duration (r=0.092, p=0.047). Conclusion: The standardized surgery checklist and new team communication promotes significantly shorter post-anesthesia wake-up times, irrespective of surgical duration. While using a comprehensive surgery checklist may take a few more minutes up front, that time is saved at the end with shorter wake-up time, creating net time savings while improving safety. Key steps to promoting a shorter intraoperative wake-up include: 1) using a bispectral index monitor (BIS) with a goal in the 50s, 2) standardized target anesthetic dosing parameters, 3) eliminated anesthetic drug variability, 4) every-thirty-minute timeouts to monitor patient status, and 5) sub-three-minute pre-surgery wake-up time goals verbalized to the OR team.

Adaptation and validation of the safe birth checklist for a public maternal and child reference hospital

Objective: to adapt and validate the World Health Organization's safe birth checklist for the Brazilian reality using a public maternal and child reference unit as a model. Method: this is a methodological study. In the first stage, the instrument was adapted based on the literature review and the guidelines of the safe birth checklist protocol. In the second stage corresponding to validation through content analysis, the adapted instrument was sent to the judges using Likert scales, consisting of 41 items. To analyze the data, the Content Validity Index was used. Results: Validity and content analysis were carried out by 17 judges working in assistance, teaching and research. Items with a Content Validity Index greater than or equal to 0.8 were maintained in full or underwent revisions as suggested by the judges. The instrument achieved an overall Content Validity Index of 0.96. Conclusion: the instrument was valid in the five dimensions studied and can be used in similar birth care services in Brazil and around the world and used in future research.

The Use of Intraoperative Neuromonitoring for Cervical Spine Surgery: Indications, Challenges, and Advances.

Intraoperative neuromonitoring (IONM) has become an indispensable surgical adjunct in cervical spine procedures to minimize surgical complications. Understanding the historical development of IONM, indications for use, associated pitfalls, and recent developments will allow the surgeon to better utilize this important technology. While IONM has shown great promise in procedures for cervical deformity, intradural tumors, or myelopathy, routine use in all cervical spine cases with moderate pathology remains controversial. Pitfalls that need to be addressed include human error, a lack of efficient communication, variable alarm warning criteria, and a non-standardized checklist protocol. As the techniques associated with IONM technology become more robust moving forward, IONM emerges as a crucial solution to updating patient safety protocols.

Immunogenicity of COVID-19 vaccines in adult patients with autoimmune inflammatory rheumatic diseases: A systematic review and meta-analysis.

COVID-19 vaccines approved by the Food and Drug Administration have been studied mainly in healthy individuals and there is limited information on their immunogenicity in patients with autoimmune diseases. Therefore, the current systematic review and meta-analysis study, aimed to comprehensively investigate the immunogenicity of these vaccines in patients with autoimmune inflammatory rheumatoid diseases (AIRDs). A comprehensive literature search was performed on various databases, including Google Scholar, PubMed, Web of Science, EMBASE, and Cochrane Library, to select cohort and randomized clinical trial (RCT) studies up to January 2022. Also, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist protocol and the I2 statistic were used for quality assessment and heterogeneity tests of the selected studies. Fixed and random-effects models were estimated based on the heterogeneity tests, and pooled data were determined as the ratio of mean (ROM) with a 95% confidence interval (CI). As a result, we found that vaccines can cause favorable immunogenicity and antibody response in vaccinated AIRD patients; however, older age and the concomitant consumption of conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) and biologic DMARDs (bDMARDs) could significantly reduce the vaccine immunogenicity. Consequently, our findings revealed significant humoral responses (seropositive) in AIRD patients following the administration of COVID-19 vaccines.

ASK! Preoperative Safety Checklist Protocol in Interventional Spine Procedures: A Quality Improvement Study Thirty Month Follow-up

Medical errors can have devastating consequences for patients. Therefore, it is crucial to prevent sentinel and wrong-side events in order to ensure patient safety. One effective tool for achieving this goal is the World Health Organization (WHO) Surgical Safety Checklist, which can be used in conjunction with a pre-procedural, multidisciplinary checklist and physician-led time-out. In a QI project that focused on interventional pain procedures, a pre-procedural, multidisciplinary checklist and physician-led time-out were implemented. Over a period of 30 months and 5,017 procedures, no near misses or incidents were recorded. These preliminary results suggest that the use of multi-disciplinary checklists and attending-led time outs can significantly improve patient safety in interventional pain procedures.

SG-APSIC1092: Bundled preoperative preparation reduced surgical-site infections

Objectives: We aimed to reduce the overall surgical-site infection (SSI) rate to 0.2%. Methods: A new checklist protocol was developed based on the APSIC guidelines. The bundle for preoperative preparation was implemented: adequate preoperative bathing, proper time of hand-forearm washing, and sufficient contact time of antiseptic application. The compliance rate was monitored with a weekly control chart from December 2019 to November 2020. Results: In total, 9,995 cases were operated at Narasuan University Hospital (NUH) in 2020, classified by surgical wound type as follows: clean wound, 62.6%; clean-contaminated wound, 32.1%; contaminated wound, 0.8%; and dirty wound, 4.5%. According to surgical wound type, the mean compliance with preoperative bathing was 68.22% for clean wounds, 68.33% for clean-contaminated wounds, and 34.82% for contaminated wounds. Hand hygiene preparation compliance was higher for clean wound surgeries (mean, 94.01%) and clean-contaminated wound surgeries (mean, 95.05%) than for contaminated wound surgeries (mean, 88.30%). A high percentage was achieved by the 3 groups. The rate of skin antiseptic preparation compliance was higher in the clean wound group (mean, 89.05%) and the clean-contaminated wound group (mean, 90.70%) than the contaminated wound group (mean, 68.12%). The lower rate might be due to time constraints in contaminated wound operations. Only 0.18% of clean-wound operations had SSIs, and the clean-contaminated wound group had 0.19% SSIs, whereas no SSIs occurred in the contaminated and dirty wound groups. The overall SSI rate was 0.17%; thus, we achieved our goal. Conclusions: A bundle of preoperative infection-prevention preparations reduced the rate of SSI. Furthermore, the bundle had a highly tangible positive impact for both internal and external stakeholders, and it was effective in ensuring good practice regarding preoperative preparation.

Oxytocin Massage Stramlining Breast Milk: Literature Riview

Oxytocin massage is massage or stimulation of the spine to release oxytocin, causing the breasts to release milk. With oxytocin massage, the mother will feel calm, relaxed, reduce pain, and love her baby, so with this the hormone oxytocin and water Mother's milk comes out quickly. The implementation of oxytocin massage therapy must be carried out effectively in order to get maximum results. Aim of this study was to identify the effectiveness of oxytocin massage therapy on increasing breast milk production in the postpartum period. This study uses a literature review using the PRISMA checklist protocol and evaluation. Search articles using two databases, namely PubMed and Scholar. The oxytocin massage intervention was effective for postpartum maternal patients on the first to third day who had not expelled colostrum or had impaired breast milk production. Oxytocin massage is effective if done twice a day with a duration of 3-5 minutes or for approximately 2-3 minutes with 2-3 massages. The implementation of oxytocin massage therapy can affect the release of colostrum in postpartum mothers. There is a need for development in other studies, including combining oxytocin massage with other non-pharmacological methods in order to further support the increase in breast milk production in the postpartum period.

The effect of immunomodulatory properties of naringenin on the inhibition of inflammation and oxidative stress in autoimmune disease models: a systematic review and meta-analysis of preclinical evidence.

Naringenin is a member of the flavonoid family that can perform many biological processes to treat a wide range of inflammatory diseases and pathological conditions related to oxidative stress (OS). Naringenin immunomodulatory activities have been the subject of recent research as an effective alternative treatment for autoimmune disorders. The effects of naringenin on the levels of inflammatory biomarkers and OS factors in animal models of autoimmune disorders (ADs) were studied in this meta-analysis. Up until January 2022, electronic databases such as Cochrane Library and EMBASE, PubMed, Web of Science, and Scopus were used to conduct a comprehensive literature search in English language. To evaluate the effect of naringenin on inflammatory mediators, such as TNF-α, IL-6, IL-β, IFN-γ, NF-κB, and nitric oxide, and OS biomarkers, such as CAT, SOD, GPx, GSH and MDA, in AD models, we measured the quality assessment and heterogeneity test using the PRISMA checklist protocol and I2 statistic, respectively. A random-effects model was employed based on the heterogeneity test, and then pooled data were standardized as mean difference (SMD) with a 95% confident interval (CI). We excluded all clinical trials, cell experiment studies, animal studies with different parameters, non-autoimmune disease models, and an inadequate series of studies for quantitative synthesis. Finally, from 627 potentially reports, 12 eligible studies were included in the meta-analysis. Data were collected from several groups. Of these, 153 were in the naringenin group and 149 were in the control group. Our meta-analysis of the pooled data for the parameters of inflammation and OS indicated that naringenin significantly reduced the levels of NF-κB (SMD -3.77, 95% CI [-6.03 to -1.51]; I2 = 80.1%, p = 0.002), IFN-γ (SMD -6.18, 95% CI [-8.73 to -3.62]; I2 = 53.7%, p = 0.115), and NO (SMD -3.97, 95% CI [-5.50 to -2.45]; I2 = 73.4%, p = 0.005), IL-1β (SMD -4.23, 95% CI [-5.09 to -3.37]; I2 = 0.0%, p = 0.462), IL-6 (SMD -5.84, 95% CI [-7.83 to -3.85]; I2 = 86.5%, p < 0.001), and TNF-α (SMD -5.10, 95% CI [-6.34 to -3.86]; I2 = 74.7%, p < 0.001). These findings also demonstrated the efficacy of naringenin on increasing the levels of CAT (SMD 4.19, 95% CI [1.33 to 7.06]; I2 = 79.9%, p = 0.007), GSH (SMD 4.58, 95% CI [1.64 to 7.51]; I2 = 90.5%, p < 0.001), and GPx (SMD 9.65, 95% CI [2.56 to 16.74]; I2 = 86.6%, p = 0.001) and decreasing the levels of MDA (SMD -3.65, 95% CI [-4.80 to -2.51]; I2 = 69.4%, p = 0.001) than control groups. However, treatment with naringenin showed no statistically difference in SOD activity (SMD 1.89, 95% CI [-1.11 to 4.89]; I2 = 93.6%, p < 0.001). Overall, our findings revealed the immunomodulatory potential of naringenin as an alternative treatment on inhibition of inflammation and OS in several autoimmune-related diseases. Nevertheless, regarding the limitation of clinical trials, strong preclinical models and clinical settings in the future are needed that address the effects of naringenin on ADs. Before large-scale clinical studies, precise human pharmacokinetic investigations are required to determine the dosage ranges and evaluate the initial safety profile of naringenin.

Dhulikhel Hospital Checklist Protocol for Temporal Bone Computed Tomography Scan Analysis: How We Do It?

The temporal bone is very complicated anatomical structure. Any disease process within this structure mandates thorough anatomical knowledge of the corresponding structure. The High resolution computed tomography (HRCT) temporal bone is the best way to look inside this complex bone. The importance of knowledge about how to read and look inside the CT scan temporal bone lead us develop the Dhulikhel Hospital Check list protocol. This protocol will help aspiring otologist and otolaryngologist to read and know details about the underlying structures.

Can a Checklist Protocol Improve Limb Lengthening?

Background: In recent years, hexapodal external fixators and telescopic nails have improved the accuracy of limb lengthening and correction of deformities. However, careful follow-up in the postoperative period is extremely important; complications are still frequent and directly interfere with patient's outcome. Aims and Objectives: We have developed a follow-up limb lengthening reconstruction checklist. Materials and Methods: Like a flight checklist, professionals systematically record relevant data in every postoperative visit, to improve clinical management during distraction and consolidating phases. Results: LLR-Checklist was used in 53 consecutive patients, from 2006 to 2020. Average age was 11 (2-45) years. A pattern was found in the 18 patients with fibular hemimelia in relation to the use of antibiotics. Superficial infection was common. 21% of patients had delayed ossification in the regenerate. 25% of patients had nerve injuries; 9,4% of them had nerve decompression, all had total recovery. Contractures and pain improved with physical therapy. Conclusion: This checklist can improve quality in the treatment and is a valuable teaching tool for young practitioners.

Neurosurgical Wrong Surgical Site in Lower-Middle- or Low-Income Countries (LMICs): A Survey Study

One of the most preventable errors of a surgeon's career is operating on the incorrect surgical site (ICSS). No study in any specialty has ever investigated the incidence of ICSS events in lower-income countries. This study focuses on identifying the occurrence of these events along with an analysis of potential causes leading to these unfortunate events. The authors distributed a survey to neurosurgical colleagues from around the world. These surgeons were first asked to identify details about their practice and incidence and personal experience with ICSS in their own careers. At the end of the survey, they responded to questions about their knowledge of safety checklists. In this study there was a 63.4% response rate. When combined with those who participated through various social media platforms, there were 178 responses. The incidence rate for every 10,000 cases performed was found to be 22.8 in the cranial group, 88.6 in the cervical group, and 158.8 in the lumbar procedural group. This study identified that 40% of participants had never learned or experienced the ABCD time-out strategy and that 60% of surgeons did not use intraoperative navigation or imaging in their practices. The error has never been disclosed to the patient in 48% of the ICSS cases. Due to a lack of application of safety checklist protocol, there is an increased occurrence of ICSS events in lower-income countries. The results of this study demonstrate the necessity of investing time and resources dedicated to avoiding preventable errors.

Effects of coenzyme Q10 supplementation on inflammation, angiogenesis, and oxidative stress in breast cancer patients: a systematic review and meta-analysis of randomized controlled- trials

Systemic inflammation and oxidative stress (OS) are associated with breast cancer. CoQ10 as an adjuvant treatment with conventional anti-cancer chemotherapy has been demonstrated to help in the inflammatory process and OS. This systematic review and meta-analysis of randomized clinical trials (RCTs) aimed to evaluate the efficacy of CoQ10 supplementation on levels of inflammatory markers, OS parameters, and matrix metalloproteinases/tissue inhibitor of metalloproteinases (MMPs/TIMPs) in patients with breast cancer. A systematic literature search was carried out using electronic databases, including PubMed, Web of Science, Scopus, Google Scholar, and Embase, up to December 2020 to identify eligible RCTs evaluating the effect of CoQ10 supplementation on OS biomarkers, inflammatory cytokines, and MMPs/TIMPs. From 827 potential reports, 5 eligible studies consisting of 9 trials were finally included in the current meta-analysis. Quality assessment and heterogeneity tests of the selected trials were performed using the PRISMA checklist protocol and the I2 statistic, respectively. Fixed and random-effects models were assessed based on the heterogeneity tests, and pooled data were determined as the standardized mean difference (SMD) with a 95% confidence interval (CI). Our meta-analysis of the pooled findings for inflammatory biomarkers of OS and MMPs showed that CoQ10 supplementation (100mg/day for 45-90days) significantly decreased the levels of VEGF [SMD:-1.88, 95% CI: (-2. 62 to-1.13); I2=93.1%, p<0.001], IL-8 [SMD:-2.24, 95% CI: (-2.68 to-1.8); I2=79.6%, p=0.001], MMP-2 [SMD:-1.49, 95% CI: (-1.85 to-1.14); I2=76.3%, p=0.005] and MMP-9 [SMD:-1.58, 95% CI: (-1.97 to-1.19); I2=79.6%, p=0.002], but no significant difference was observed between CoQ10 supplementation and control group on TNF-α [SMD:-2.30, 95% CI: (-2.50 to-2.11); I2=21.8%, p=0.280], IL-6 [SMD:-1.56, 95% CI: (-1.73 to-1.39); I2=0.0%, p=0.683], IL-1β [SMD:-3.34, 95% CI: (-3.58 to-3.11); I2=0.0%, p=0.561], catalase (CAT) [SMD: 1.40, 95% CI: (1.15 to 1.65); I2=0.0%, p=0.598], superoxide dismutase (SOD) [SMD: 2.42, 95% CI: (2.12 to 2.71); I2=0.0%, p=0.986], glutathione peroxidase (GPx) [SMD: 2.80, 95% CI: (2.49 to 3.11); I2=0.0%, p=0.543]], glutathione (GSH) [SMD: 4.71, 95% CI: (4.26 to 5.16); I2=6.1%, p=0.302] and thiobarbituric acid reactive substances (TBARS) [SMD:-3.20, 95% CI: (-3.53 to-2.86); I2=29.7%, p=0.233]. Overall, the findings showed that CoQ10 supplementation reduced some of the important markers of inflammation and MMPs in patients with breast cancer. However, further studies with controlled trials for other types of cancer are needed to better understand and confirm the effect of CoQ10 on tumor therapy.

A systematic approach to contouring and polishing anterior resin composite restorations: A checklist manifesto.

This article presents a systematic, step-by-step checklist approach to be used for contouring and polishing anterior resin composite restorations to achieve maximum esthetics efficiently. This checklist is intended to be used to take the guesswork out and streamline the process to predictably, practically, and repeatedly contour and polish anterior resin composite restorations. The practitioner's knowledge of basic dental anatomy combined with this step-by-step checklist facilitates identifying and modifying the final restoration to an anatomically correct form, thus satisfying the most esthetically demanding patients. This approach is demonstrated with case presentation of direct resin veneers in a young female, which resulted in an improved smile that satisfied her esthetic desires. The use of standardized protocols facilitates and expedites daily procedures in dentistry. Specifically, this checklist protocol, which is geared towards contouring and polishing anterior direct resin composite restorations. The clinical technique presented in this article shows the advantages of using a step-by-step checklist approach to predictably and efficiently obtain ideal esthetics when performing anterior resin composite restorations.

Extending the RIGHT statement for reporting adapted practice guidelines in healthcare: the RIGHT-Ad@pt Checklist protocol

IntroductionThe adaptation of guidelines is an increasingly used methodology for the efficient development of contextualised recommendations. Nevertheless, there is no specific reporting guidance. The essential Reporting Items of Practice Guidelines...

The Zurich Checklist for Safety in the Intraoperative Magnetic Resonance Imaging Suite: Technical Note.

BACKGROUNDRecently, the use of intraoperative magnetic resonance imaging (ioMRI) has evolved in neurosurgery. Challenges related to ioMRI-augmented procedures are significant, since the magnetic field creates a potentially hazardous environment. Strict safety guidelines in the operating room (OR) are necessary. Checklists can minimize errors while increasing efficiency and improving workflow.OBJECTIVETo describe the Zurich checklists for safety in the ioMRI environment.METHODSWe summarize the checklist protocol and the experience gained from over 300 surgical procedures performed over a 4-yr period using this new system for transcranial or transsphenoidal surgery in a 2-room high-field 3 Tesla ioMRI suite.RESULTSParticularities of the 2-room setting used at our institution can be summarized as (1) patient transfer from a sterile to a nonsterile environment and (2) patient transfer from a zone without to a zone with a high-strength magnetic field. Steps on the checklist have been introduced for reasons of efficient workflow, safety pertaining to the strength of the magnetic field, or sterility concerns. Each step in the checklist corresponds to a specific phase and particular actions taken during the workflow in the ioMRI suite. Most steps are relevant to any 2-room ioMRI-OR suite.CONCLUSIONThe use of an ioMRI-checklist promotes a zero-tolerance attitude for errors, can lower complications, and can help create an environment that is both efficient and safe for the patient and the OR personnel. We highly recommend the use of a surgical checklist when applying ioMRI.

Lausanne checklist for safe stereotactic radiosurgery.

Stereotactic radiosurgery (SRS) is increasingly used as a minimally invasive alternative in many neurosurgical conditions, including benign and malignant tumors, vascular malformations, and functional procedures. As for any surgical procedure, strict safety guidelines and checklists are necessary to avoid errors and the inherent unnecessary complications. With regard to the former, other groups have already reported human and/or technical errors. We describe our safety checklist for Gamma Knife radiosurgical procedures. We describe our checklist protocol after an experience gained over 1500 radiosurgical procedures, using Gamma Knife radiosurgery, performed over a period of 8years, while employing the same list of items. Minor implementation has been performed over time to address some safety issues that could be improved. Two types of checklist are displayed. One is related to the indications when a specific tissue volume is irradiated, including tumors or vascular disorders. The second corresponds to functional disorders, such as when the dose is prescribed to one specific point. Using these checklists, no human error had been reported during the past 8years of practice in our institution. The use of a safety checklist for SRS procedures promotes a zero-tolerance attitude for errors. This can lower the complications and is of major help in promoting multidisciplinary cooperation. We highly recommend the use of such tool, especially in the context of the increased use of SRS in the neurosurgical field.

Joint awareness in posttraumatic osteoarthritis of the knee: validation of the forgotten joint score in long term condition after tibial plateau fracture

BackgroundEvaluating patient-reported outcomes (PRO) in early osteoarthritis (OA) of the knee is difficult. Established measurement tools are focused on one of the two major patient groups in knee surgery: young, highly active patients, or older patients with advanced degenerative OA of the knee. Joint awareness in everyday life is a crucial criterion in measuring PRO. The purpose of this study was to validate a German version of the “Forgotten Joint Score” (FJS) in patients after surgical treatment of tibial plateau fractures.MethodsIn this prospective cohort study, clinical and radiological outcomes data were collected from patients after surgical treatment of tibial plateau fractures following a skiing accident. Functional outcome questionnaires were administered including the FJS, the Lysholm-Score, the Tegner-Activity Scale (TAS), the EuroQol-5D (EQ 5-D), and a subjective rating of change. The validation study was carried out according to the COSMIN checklist protocol. The KLS was used to measure the presence and severity of OA on knee radiographs, and correlation with the FJS was measured.ResultsCronbach‘s alpha was .96 (95%-CI .92, .99) confirming good internal consistency. Test-retest reliability of the FJS was high with an ICC(67) = .91 (95%-CI .85,.95). Furthermore, no relevant floor or ceiling effects were observed. FJS significantly differed in patients with different OA degrees (p = .041). Symptomatic patients had significant lower FJS than asymptomatic patients (p < .001).ConclusionsThis is the first study validating a disease-specific PRO, the FJS, in long-term outcomes after joint fracture. We demonstrated good psychometric properties and a significant correlation between the FJS and the radiologic degree of OA in patients with a history of tibial plateau fracture.Trial registrationClinical Trial Registry University of Regensburg Z-2015-0872-2. Registered 01. October 2015.