Use Of Registry Data Research Articles

A Retrospective Case-Control Study on the Differences in the Effectiveness of Theta-Burst Stimulation Therapy for Depression with and without Antidepressant Medication.

Transcranial magnetic stimulation (TMS) therapy has few side effects and comparable therapeutic effects to antidepressant treatment, but few studies have introduced TMS therapy as an initial treatment for MDD. The objective of this study was to retrospectively compare the clinical outcomes between 50 MDD patients without antidepressants (i.e., TMS monotherapy) and 50 MDD patients with antidepressants plus TMS therapy, matched for age, sex, and depression severity. The presence or absence of antidepressant therapy in first-line treatment was determined via a detailed interview by psychiatrists. The study design was a retrospective observational case-control study using the TMS registry data. The key inclusion criteria were adult patients who met the diagnosis of MDD and received 20-30 sessions of intermittent theta-burst stimulation (iTBS) therapy to the left dorsolateral prefrontal cortex (DLPFC). In this study, the Montgomery-Åsberg Depression Rating Scale (MADRS) was used as the primary outcome measure. No significant group differences existed in the baseline MADRS total score between the unmedicated and medicated patient groups. Following TMS therapy, no significant group differences in response rate, remission rate, or relative total score change in the MADRS were observed. The main limitations were the retrospective design and the use of registry data as a source. Our findings suggest that TMS monotherapy may be as effective as TMS add-on therapy to antidepressants when used as the first-line therapy for MDD, but randomized controlled trials are needed.

Innovations in use of registry data (INOREG)

Abstract: In recent years there have been several political initiatives in Norway, requiring more research into how multimorbidity and health care pathways in the municipality affect outcomes such as work participation, hospital admissions, disability and quality of life for patients with chronic diseases. Most of the care is provided outside hospitals and has been difficult to capture in large, registry-based studies. Focusing on two important groups, patients with chronic obstructive pulmonary disease (COPD) and musculoskeletal disorders (MSD), the INOREG project aims to reduce these knowledge gaps. In the paper we present 1) the data that are used in the project, 2) the construction of samples, variables and possible methods for analysis and 3) an example on how the data and methods will be applied. The project database is constructed from a novel linkage of national health and welfare registries. The data cover social, primary and specialized care for all COPD and MSD patients in Norway, long-term care data from Oslo and Trondheim municipalities and functioning and quality of life for ca. 2,700 patients treated at physiotherapy clinics in the FYSIOPRIM project. This enables construction of care pathways and outcomes at the individual level from 2008 through 2019. The project will fill knowledge gaps regarding the patterns of care at different levels in the health care system, and the association to outcomes for chronic patient groups. If the project is successful, it will provide improved insight on how to further develop provision and coordination of services to the decision makers, and ideally reduce inequalities in health.

OP171 Canadian Disease Registry Inventory: Environmental Scan Of The Literature

IntroductionIn consideration of the lessons learned from other jurisdictions and other ongoing work in the disease registry data space, an opportunity existed to investigate the current Canadian landscape and identify opportunities for a Canadian registry list. Previously, no national-level inventory of registries existed in Canada that could provide the necessary information to support awareness and use of available data for decision-making.MethodsA literature search was conducted on key resources, including MEDLINE and a focused internet scan. No methodological filters were applied to limit retrieval by publication type. The search was limited to documents published in English or French.ResultsCore characteristics of the identified registries were extracted and contextual information on the current landscape of disease registries in Canada was explored. A literature review and draft inventory list has been produced.ConclusionsA CADTH environmental scan was undertaken to collect and report on existing Canadian disease registries and to identify key features, characteristics, and intersections. This information and analysis increase the potential of Canadian registries to inform decision-making and identifies opportunities for the optimal use of registry data in Canada more broadly.

Population-Based Clinical Cancer Registration in Germany.

In 2013, a new federal law obligated all German federal states to collect additional clinical data in population-based cancer registries as an active tool for monitoring and improving the quality of cancer care, increasing transparency and promoting health research. Now, 10 years later, the current status of the expanded cancer registration is presented, including current figures on cancer in Germany. Reporting of cancer is mandatory for physicians, and about 5 to 10 reports from different healthcare providers are expected for each case. A uniform national dataset of about 130 items is used, and reports are usually sent electronically to the registry. We used the most recent data available from cancer registries up to the year of diagnosis in 2019. We calculated incidence rates and 5-year relative survival (5YRS) for common cancers. Data on clinical outcomes and benchmarking based on quality indicators (QIs) from guidelines were provided by the Cancer Registry Schleswig-Holstein (CR SH). All federal state cancer registries met most of the previously defined national eligibility criteria. Approximately 505,000 cancer cases were registered in 2019, with breast, prostate, colorectal and lung cancer being the most common cancers. The age-standardised cancer incidence has slightly decreased during the last decade. and spatial heterogeneity can be observed within Germany. 5YRS for all cancers was 67% and 63% for women and men, respectively. Therapy data for rectal cancer in 2019-2021 from the CR SH are shown as an example: 69% of the registered patients underwent surgery, mostly with curative intent (84%) and tumour-free resection (91%). Radiotherapy was given to 33% of the patients, and chemotherapy was given to 40%. Three selected QIs showed differences between involved healthcare providers. The implementation of population-based clinical cancer registration can be considered a success. Comprehensive recording of diagnosis, treatment and disease progression and the use of registry data for quality assurance, benchmarking and feedback have been implemented.

Excess mortality after kidney transplantation: does sex matter?

Understanding sex differences in graft outcomes within the course of kidney transplantation is needed to unravel factors leading to the observed disparities and further improve patient management. In this issue, Vinson etal. presented a relative survival analysis comparing the excess risk of mortality in female and male recipients after kidney transplantation. This commentary discusses the major findings but also the challenges of the use of registry data to conduct large-scale analyses.

Mobilizing registry data for quality improvement: A convergent mixed-methods analysis and application to spinal cord injury.

The rising prevalence of complex chronic conditions and growing intricacies of healthcare systems emphasizes the need for interdisciplinary partnerships to advance coordination and quality of rehabilitation care. Registry databases are increasingly used for clinical monitoring and quality improvement (QI) of health system change. Currently, it is unclear how interdisciplinary partnerships can best mobilize registry data to support QI across care settings for complex chronic conditions. We employed spinal cord injury (SCI) as a case study of a highly disruptive and debilitating complex chronic condition, with existing registry data that is underutilized for QI. We aimed to compare and converge evidence from previous reports and multi-disciplinary experts in order to outline the major elements of a strategy to effectively mobilize registry data for QI of care for complex chronic conditions. This study used a convergent parallel-database variant mixed design, whereby findings from a systematic review and a qualitative exploration were analyzed independently and then simultaneously. The scoping review used a three-stage process to review 282 records, which resulted in 28 articles reviewed for analysis. Concurrent interviews were conducted with multidisciplinary-stakeholders, including leadership from condition-specific national registries, members of national SCI communities, leadership from SCI community organizations, and a person with lived experience of SCI. Descriptive analysis was used for the scoping review and qualitative description for stakeholder interviews. There were 28 articles included in the scoping review and 11 multidisciplinary-stakeholders in the semi-structured interviews. The integration of the results allowed the identification of three key learnings to enhance the successful design and use of registry data to inform the planning and development of a QI initiative: enhance utility and reliability of registry data; form a steering committee lead by clinical champions; and design effective, feasible, and sustainable QI initiatives. This study highlights the importance of interdisciplinary partnerships to support QI of care for persons with complex conditions. It provides practical strategies to determine mutual priorities that promote implementation and sustained use of registry data to inform QI. Learnings from this work could enhance interdisciplinary collaboration to support QI of care for rehabilitation for persons with complex chronic conditions.

Trusted Data Spaces as a Viable and Sustainable Solution for Networks of Population-Based Patient Registries.

Harmonization and integration of health data remain as the focus of many ongoing efforts toward the goal of optimizing health and health care policies. Population-based patient registries constitute a critical element of these endeavors. Although their main function is monitoring and surveillance of a particular disease within a given population, they are also an important data source for epidemiology. Comparing indicators across national boundaries brings an extra dimension to the use of registry data, especially in regions where supranational initiatives are or could be coordinated to leverage good practices; this is particularly relevant for the European Union. However, strict data protection laws can unintentionally hamper the efforts of data harmonization to ensure the removal of statistical bias in the individual data sets, thereby compromising the integrated value of registries' data. Consequently, there is the motivation for creating a new paradigm to ensure that registries can operate in an environment that is not unnecessarily restrictive and to allow accurate comparison of data to better ascertain the measures and practices that are most conducive to the public health of societies. The pan-European organizational model of cancer registries, owing to its long and successful establishment, was considered as a sound basis from which to proceed toward such a paradigm. However, it has certain drawbacks, particularly regarding governance, scalability, and resourcing, which are essential elements to consider for a generic patient registry model. These issues are addressed in a proposal of an adapted model that promises a valuable pan-European data resource for epidemiological research, while providing a closely regulated environment for the processing of pseudonymized patient summary data on a broader scale than has hitherto been possible.

Guidelines of the International Headache Society for Clinic-Based Headache Registries, 1st edition.

Clinic-based headache registries collect data for a wide variety of purposes including delineating disease characteristics, longitudinal natural disease courses, headache management approaches, quality of care, treatment safety and effectiveness, factors that predict treatment response, health care resource utilization, clinician adherence to guidelines, and cost-effectiveness. Registry data are valuable for numerous stakeholders, including individuals with headache disorders and their caregivers, healthcare providers, scientists, healthcare systems, regulatory authorities, pharmaceutical companies, employers, and policymakers. This International Headache Society document may serve as guidance for developing clinic-based headache registries. Use of registry data requires a formal research protocol that includes: 1) research aims; 2) methods for data collection, harmonization, analysis, privacy, and protection; 3) methods for human subject protection; and 4) publication and dissemination plans. Depending upon their objectives, headache registries should include validated headache-specific questionnaires, patient reported outcome measures, data elements that are used consistently across studies (i.e., "common data elements"), and medical record data. Amongst other data types, registries may be linked to healthcare and pharmacy claims data, biospecimens, and neuroimaging data. Headache diagnoses should be made according to the International Classification of Headache Disorders diagnostic criteria. The data from well-designed headache registries can provide wide-ranging and novel insights into the characteristics, burden, and treatment of headache disorders and ultimately lead to improvements in the management of patients with headache.

Commentary on Chai et al: Drug use, self-harm, suicide, and use of registry data in epidemiological research.

A study of specific drugs as risk factors for suicide and self-harm can be linked to the bigger issue of the relative harm of various substances. The role and impact of the interplay between psychiatric co-morbidity and impulsivity can be related more widely to the link between substance use and self-harm and suicide. Chai et al. [1] have made an important contribution to the literature on substance use and self-harm and suicide (SHS) by linking specific types of substance use disorders recorded at presentation to accident and emergency departments to subsequent SHS, using a population-based cohort in Hong Kong. Chai et al. [1] used an epidemiological framework with control for multiple factors to assess the contribution of each drug to SHS and adjusted their analyses for psychiatric co-morbidity, which is an extremely important confounder, because psychiatric co-morbidity is the single strongest predictor of SHS and is closely related to substance use [2]. Compared with other patients, patients with drug use disorders, regardless of type of drug, were at elevated risk for SHS. The authors concluded that all types of drug use disorders pose a risk of SHS and underlined the importance of approaches that seek to prevent and regulate drug use, including supply-oriented approaches. It is notable that some drugs, such as ketamine and opioids, were associated with very high risk of SHS, whereas other drugs, such as hallucinogens or cannabis, were associated with somewhat lower risk of SHS. Similarly, in some previous studies, psycho-depressants, such as opioids or alcohol, were associated with completed suicide, whereas cannabis and stimulants were not [2]. Further, Chai et al. [1] found that previous drug use disorders and psychiatric disorders were significantly associated with increased risk of SHS, but noted that this link is complicated and that the potential contribution of state impulsivity to SHS because of drug use disorders should be considered. The findings from their study fit into the framework of degrees of harm from various substances exemplified by the work of Nutt and colleagues [3, 4] and are a prime example of what can be achieved by using register data. By understanding how various drugs contribute to harms, it is possible to prioritize the often scarce health service and law enforcement resources [5]. Longitudinal research, as presented by Chai et al. [1], can indicate that a drug may be an important contributor to an adverse outcome. Using record-linkage to predict future outcomes is an under-used method in substance use research and is able to produce knowledge about exactly the kind of links identified in this study [6]. However, if such findings are to inform policy and practice, it is important to try to identify causal links rather than simply longitudinal associations [7]. When considering whether adverse outcomes such as SHS are directly attributable to the use of a specific drug, cross-cultural robustness of associations, biological plausibility, dose–response relationships, and experimental evidence from laboratory findings can all contribute to understanding the contribution of the drug itself, and therefore, the implications for practice and policy. Importantly, the increased risk associated with specific drugs found in the study by Chai et al. [1] must be considered in relation to the local drug and alcohol culture and to differences in access to and use of health care services. Considering the current evidence base, we are not yet at the point where we can safely say that SHS is a consequence of drug use. However, studies such as the one by Chai et al. [1] point to the possibility that some substances do increase the risk. We wish to thank doctoral student Julie Brummer for her useful input on the manuscript before submission. None. Morten Hesse: Conceptualization. Birgitte Thylstrup: Conceptualization. Jens Skogen: Conceptualization.

Automated data extraction into acataract surgery registry : Automatic investigation of results in the registry on ophthalmological analysis (ROPHA)

Medical data should be evaluated with respect to quality management, for scientific and research purposes on the basis of registries. These data are stored in the EMR in an unstructured way and are not suitable for automatic evaluation. The EMR tomedo (Zollsoft/Jena) and the PACS of FORUM (Zeiss/Oberkochen) manage personal, medical and image data for cataract surgery. New developed input masks gather data from diagnostic tools direct in astructured way. These data are automatically extracted by an ETL process and are stored in our data warehouse. Via Excel specific data can be selected and displayed in the dashboard. All medical data are structured and stored electronically. Few data are entered manually and most of the data are entered by pull-down menus or taken over directly from diagnostic equipment. A total of 2816 cataract surgeries of 1844patients were selected for afirst analysis. Results of IOL type distribution in relation to the patients and to the surgeons are displayed as well as prediction error of refraction for the 4different groups of IOLs. Structured data input into the EMR (electronic medical record) makes data for automatic extraction available thus reducing input errors or confounding data. The result is ahigh quality of data sets. Input of epidemiological and general medical data also helps to perform health services research. These registry data represent better information for real live data than data from clinical trials. Bureaucratic hurdles in Germany prevent the use of registry data.

Registries: Big data, bigger problems?

Patient registries have grown in size and number along with general computing power and digitization of the healthcare world. In contrast to databases, registries are typically patient data systematically created and collected for the express purpose of answering health-related questions. Registries can be disease-, procedure-, pathology-, or product-based in nature. Registry-based studies typically fit into Level II or III in the hierarchy of evidence-based medicine. However, a recent advent in the use of registry data has been the development and execution of registry-based trials, such as the TASTE trial, which may elevate registry-based studies into the realm of Level I evidence. Some strengths of registries include the sheer volume of data, the inclusion of a diverse set of participants, and their ability to be linked to other registries and databases. Limitations of registries include variable quality of the collected data, and a lack of active follow-up (which may underestimate rates of adverse events). As with any study type, the intended design does not automatically lead to a study of a certain quality. While no specific tool exists for assessing the quality of a registry-based study, some important considerations include ensuring the registry is appropriate for the question being asked, whether the patient population is representative, the presence of an appropriate comparison group, and the validity and generalizability of the registry in question. The future of clinical registries remains to be seen, but the incorporation of big data and machine learning algorithms will certainly play an important role.

PP254 Double-Counting In Evidence Synthesis Including Routinely Collected Data: Methodological and Practical Considerations

IntroductionThe use of real-world data, as an alternative to randomized controlled trials, is becoming increasingly common in the evaluation of new health technologies. With this rise in real-world literature, such data will also enter evidence synthesis models. While it can be beneficial to utilize data from all available sources, this can introduce the problem of double-counting of participants.MethodsUsing a number of case-studies, we discuss and illustrate various issues around double-counting. These include synthesis of studies using the same database or the same subset of participants, overlapping use of intervention arms across studies and the use of registry data from the participants overlapping with those in randomized controlled trials. The implications in research are considered along with common methods used currently to overcome these issues.ResultsDouble-counting of participants in evidence synthesis can artificially inflate precision, potentially leading to inappropriate conclusions. Common methods currently used to help mitigate the impact of double-counting includes stratifying analysis to different timelines, using the most comprehensive study in the evidence synthesis model or using the study that has the largest sample size. However, in all of these cases, sensitivity analyses would need to be considered to ensure robust results.ConclusionsCurrently, there are no published guidelines on how to address the issue of double-counting. With the increased use of real-world data in evidence synthesis, double-counting has the potential to become a significant issue. Therefore, it is of significant importance that methodologies and guidelines are developed to address this.

A tool to assess the registries quality: The Registry Evaluation and Quality Standards Tool (REQueST)

Abstract Background The use of registries is increasingly common in HTA as interest grows in the use of observational data to complement trial data and optimize access to new technologies. Registry data quality has been criticized, leading to reluctance to embed their use in HTA. During EUnetHTA Joint Action 3 the HTA network has produced a draft standard tool to assess registry quality. Methods The development phase included: analysis of the current use of registry data by HTA bodies (HTAb), HTAb consultation on the first draft of the tool, HTAb and stakeholder consultation on the second draftl, tool testing by three HTAb. Finally, the near-final version was submitted for public consultation. The feedback helped prepare the final version of the tool, available at https://eunethta.eu/request-tool-and-its-vision-paper/. Results The standards in REQueST are universal and essential elements of good practice and evidence quality that are relevant and applicable to different registry types. It includes three sections: 8 ‘methodological' items relating to suitability of the registry for a specific purpose; 13 ‘essential standards' relevant to any registry for HTA and 3 additional considerations for specific purposes. REQueST builds upon existing guidance and provides a means to adopt and implement best practice. It can be used by both evidence developers to assess the quality of their registry and HTA bodies and Regulators when considering whether to use them. EUnetHTA partners are encouraged to use the tool in all joint activities in which registry quality is to be defined or assessed. Moreover, EUnetHTA partners can use the tool on individual basis when assessing the quality of registries for HTA purposes. Since its publication REQueST has been used in two EUnetHTA registry qualifications and several national HTA activities related to Post Launch Evidence Generation (PLEG). Some of the national PLEG activities reported very positive feedback on the tool from registry holders.

Are clinicians using routinely collected data to drive practice improvement? A cross-sectional survey

Clinical registry participation is a measure of healthcare quality. Limited knowledge exists on Australian hospitals' participation in clinical registries and whether this registry data informs quality improvement initiatives. To identify participation in clinical registries, determine if registry data inform quality improvement initiatives, and identify registry participation enablers and clinicians' educational needs to improve use of registry data to drive practice change. A self-administered survey was distributed to staff coordinating registries in seven hospitals in New South Wales, Australia. Eligible registries were international-, national- and state-based clinical, condition-/disease-specific and device/product registries. Response rate was 70% (97/139). Sixty-two (64%) respondents contributed data to 46 eligible registries. Registry reports were most often received by nurses (61%) and infrequently by hospital executives (8.4%). Less than half used registry data 'always' or 'often' to influence practice improvement (48%) and care pathways (49%). Protected time for data collection (87%) and benchmarking (79%) were 'very likely' or 'likely' to promote continued participation. Over half 'strongly agreed' or 'agreed' that clinical practice improvement training (79%) and evidence-practice gap identification (77%) would optimize use of registry data. Registry data are generally only visible to local speciality units and not routinely used to inform quality improvement. Centralized on-going registry funding, accessible and transparent integrated information systems combined with data informed improvement science education could be first steps to promote quality data-driven clinical improvement initiatives.

The Outcomes of Thoracic Endovascular Aortic Repair in Japan in 2017: A Report from the Japanese Committee for Stentgraft Management.

Thoracic endovascular aortic repair (TEVAR) was initially used in treating descending thoracic aortic aneurysms back in 1992.1) It was then approved by the United States Food and Drug Administration in 2005. Since then, TEVAR has been adopted worldwide and has been improved dramatically, both procedurally and in terms of available materials. In Japan, TEVAR is identified as the standard treatment for descending thoracic aneurysms.2) The emergence of fenestrated stent grafts to better fit the angulated morphology of the thoracic arch and of the lower profile and the 2015 approval of TEVAR for aortic dissection have led to an increase in the annual number of TEVAR procedures performed in Japan. However, the outcomes of TEVAR are yet to be evaluated in a large cohort. Thus, in this study, we aim to report the number of TEVAR procedures conducted in Japan in 2017, including its mortality and complication rates, by using the data from the Japanese Committee for Stentgraft Management (JACSM) nationwide registry; this data covers the outcomes of nearly all of the stent grafts shipped to Japan.3,4) JACSM and database The JACSM nationwide registry, including its foundations, structure, and quality control, has already been previously described in detail.3,4) The JACSM, established in December 2006, is composed of 10 societies related to endovascular treatment and determined the practical standards for institutions and for practicing and supervising surgeons. Participating institutions were obligated to report their data on endovascular aneurysm repair (EVAR) and TEVAR, using a web-based case-registry form (http://www.stentgraft.jp/). The information collected as regards TEVAR included preoperative information, anatomical factors evaluated during operative planning, and data obtained in the immediate postoperative period, at discharge, at 6 months postoperative, and at each year after that. As of 2015, 366 institutes in Japan had been certified for TEVAR by the JACSM. This registry was conducted in accordance to the principles of the Declaration of Helsinki, the International Conference on Harmonization, and Good Clinical Practice guidelines. The use of registry data was approved by the Institutional Review Board of the University of Tokyo Hospital (approval number: 2019306NI).

Pregnancy in Classical Paroxysmal Nocturnal Hemoglobinuria and Aplastic Anemia-Paroxysmal Nocturnal Hemoglobinuria: A High-Risk Constellation.

Pregnancies in paroxysmal nocturnal hemoglobinuria (PNH) are associated with increased morbidity and mortality. Retrospective studies suggest that outcome has improved with the advent of the complement inhibitor eculizumab. To substantiate this assumption we analyzed the data from patients treated in our department since 2009. All patients were included in the International PNH registry and followed prospectively. We identified 16 pregnancies in 9 patients with classical PNH, and two pregnancies in two patients with aplastic anemia (AA)-PNH. In classical PNH, 13 pregnancies were supported by eculizumab. Breakthrough hemolysis occurred in six pregnancies, necessitating an increase in the biweekly eculizumab dose from 900 mg to 1,200–1,800 mg. Red blood cell transfusions were given in six and platelet transfusions in two pregnancies. A Budd-Chiari syndrome and cholecystitis complicated the course of two pregnancies. Four of 13 pregnancies supported by eculizumab ended in spontaneous abortion or stillbirth, and one was prematurely terminated because of fetal trisomy 21. None of the three pregnancies not supported by eculizumab had a successful outcome. Half the deliveries were preterm. None of the patients died, and, in all but one patient, the post-partum period was uneventful. Both pregnancies in patients with AA-PNH took a favorable course. Our results confirm low maternal mortality and frequent breakthrough hemolysis in pregnant PNH patients receiving eculizumab. Fetal mortality and the rate of preterm delivery were higher than reported previously, possibly related to the use of registry data that are likely to reduce the risk of publication and recall biases.

The Japanese Transplant Registry Unified Management Program (TRUMP®): current issues and the future

The annual number of hematopoietic cell transplantation (HCT) in Japan exceeds 5,500 in recent years, and a steady increase in the HCT activity is observed globally. Transplant Registry Unification Management Program (TRUMP®) data, the HCT outcome registry data (or real-world data) in Japan, played important roles in improving the therapeutic outcomes of HCT. Registry studies are actively performed by working groups, and >20 papers are published yearly using the TRUMP® data. The development of shared scripts has contributed to improving the quality of registry data analyses. In January 2020, the TRUMP® survey items were significantly revised according to the World Health Organization's disease classification revision and addition of new drug information, and >600 survey items were newly added. The quality control system for registry studies should be updated in response to this major change. The HCT registry is becoming HCT and cell therapy registry and is expected to expand the use of registry data, including the international collaborative research.

Summary of knee implant one, three, five, and 10-year revision risk reported by national and regional arthroplasty registries: a valuable source of evidence for clinical decision-making.

Optimal implant selection is a major component of high-quality arthroplasty care, and revision risk is an important parameter characterizing knee arthroplasty implant clinical performance.National and regional arthroplasty registries are essential sources of revision risk data, but these data are often difficult to find because they are buried within extensive annual reports. Summarizing total knee arthroplasty (TKA) implant revision risks as presented in registry reports can maximize the usefulness of registry data for orthopaedic surgeons.The findings summarize the revision risk data found in national arthroplasty reports from the Australian, Danish, Finnish, and the England, Wales, Northern Ireland and the Isle of Man registries, and in regional arthroplasty reports from the Emilia-Romagna Region (Italty), and the Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI) registries.The six supplemental summary tables present revision risk data for TKA implants by cemented, uncemented, hybrid, and unreported fixation types. Additional summary tables are presented for revision risk of unicondylar (UKA) and patellofemoral joint (PFJ) revisions. Within TKA fixation categories, revision risks at 10 years ranged from 2.4% to 35.7% (cemented), 2.8% to 25.0% (uncemented), 2.0% to 9.2% (hybrid), and 0.0% to 39.7% (unreported). Unicondylar 10-year revision risk ranged from 4.9% to 17.2%. Patellofemoral joint 10-year revision risk ranged from 15.2% to 21.7%.There is substantial variation in one, three, five, and 10-year revision risk across implants, which suggests surgeons should choose implants carefully.Cite this article: EFORT Open Rev 2020;5:268-272. DOI: 10.1302/2058-5241.5.190053

Editorial note: welcome to Volume 23 and the year 2020

The Editorial Board of African Journal of Nephrology (AJN) and I wish all readers, contributors and reviewers a very happy and successful year 2020. The year 2019 was a very productive year for AJN and the African Association of Nephrology (AFRAN). The 2019 AFRAN congress, held from 25 to 29 September 2019 in Mombasa (Kenya), was a very successful one, with the participation of hundreds of delegates from all regions of Africa. The congress was held in partnership with the Kenya Renal Association and the African Paediatric Nephrology Association (AFPNA). The main congress was preceded by several successful courses. Prof Antony Were from Kenya was elected President of AFRAN. The next AFRAN congress will be held next year in Côte d’Ivoire. In 2019, we published excellent reviews covering global disparities in kidney disease and its treatment as well as the use of data from renal registries in randomised controlled trials. We therefore encourage our readers to participate in the collection of data for registries as well as to make use of registry data for research. The AJN 2019 volume also published excellent original articles that showcased the strength of clinical nephrology research in various regions of Africa. The year 2020 is expected to witness several national and regional nephrology meetings. I urge all convenors to use AJN to publicize their meetings, as well as publish their proceedings. The World Congress of Nephrology will take place in Abu Dhabi from 26 to 29 March 2020. This year, World Kidney Day is scheduled for Thursday, 12 March 2020. The theme is “Kidney Health for Everyone Everywhere – from Prevention to Detection and Equitable Access to Care”. I am confident that, in 2020, AJN will continue the trends set in the previous year, by publishing outstanding in-depth review articles as well as interesting original research articles. Finally, I am pleased to announce that this year, the South African Renal Society Congress will take place in Durban at the International Convention Centre, from 25-29 November 2020. The theme of the congress is “Big Data and Access to Quality Renal Care”. As President of the Local Organising Committee, I invite everyone to SARS Congress 2020. WOZA – DURBAN! Alain G AssoungaEditor-in-Chief

Consolidated quality improvements following benchmarking with cardiothoracic surgery registries-a systematic review.

The influence of registries in medicine is large. However, there has been no systematic assessment conducted to quantify the impact of benchmarking with registries focused on cardiothoracic surgery. Numerous publications conclude that registry participation leads to improvement of outcomes for patients. A large number of registries provide evidence sub-structured by statistics that show decreases in morbidity and mortality in the participants' clinical units. Many authors praise the benchmarking method making use of databases of registries as having a positive effect on outcome of care. However, studies proving the direct causal relation between the use of cardiothoracic surgery-oriented registries and improvement of clinical in-hospital outcomes are extremely scarce. We aimed to analyse the causal relation between the use of cardiothoracic surgery-oriented registries and improvement of clinical outcomes. In a systematic literature review, publications demonstrating the use of registry data to obtain consolidated quality improvements were selected. After analysis of 2990 scientific publications, 6 studies filled the inclusion criteria. The selected studies acknowledged that benchmarking of data against registries was used for a focused and methodologically organized improvement in cardiothoracic departments. In conjunction with the impact of the applied methods on healthcare, their results demonstrate quantifiable enhanced local outcomes over time.