Abstract:
BACKGROUND:Research addressing the burden of musculoskeletal disease in low- and middle-income countries does not reflect the magnitude of the epidemic in these countries as only 9% of the world's biomedical resources are devoted to addressing problems that affect the health of 90% of the world's population. Little is known regarding the barriers to and drivers of orthopaedic surgery research in such resource-poor settings, the knowledge of which would help direct specific interventions for increasing research capacity and help surgeons from high-income countries support the efforts of our colleagues in low- and middle-income countries. PURPOSE:We sought to identify through surveying academic orthopaedic surgeons in East Africa: (1) barriers impeding research, (2) factors that support or drive research, and (3) factors that were identified by some surgeons as barriers and others as drivers (what we term barrier-driver overlap) as they considered the production of clinical research in resource-poor environments. MATERIALS:Semistructured interviews were conducted with 21 orthopaedic surgeon faculty members at four academic medical centers in Ethiopia, Kenya, Tanzania, and Uganda. Qualitative content analysis of the interviews was conducted using methods based in grounded theory. Grounded theory begins with qualitative data, such as interview transcripts, and analyzes the data for repeated ideas or concepts which then are coded and grouped into categories which allow for identification of subjects or problems that may not have been apparent previously to the interviewer. RESULTS:We identified and quantified 19 barriers to and 21 drivers of orthopaedic surgery research (mentioned n = 1688 and n = 1729, respectively). Resource, research process, and institutional domains were identified to categorize the barriers (n = 7, n = 5, n = 7, respectively) and drivers (n = 7, n = 8, n = 6, respectively). Resource barriers (46%) were discussed more often by interview subjects compared with the research process (26%) and institutional barriers (28%). Drivers of research discussed at least once were proportionally similar across the three domains. Some themes such as research ethics boards, technology, and literature access occurred with similar frequency as barriers to and drivers of orthopaedic surgery research. CONCLUSIONS:The barriers we identified most often among East African academic orthopaedic faculty members focused on resources to accomplish research, followed by institutional barriers, and method or process barriers. Drivers to be fostered included a desire to effect change, collaboration with colleagues, and mentorship opportunities. The identified barriers and drivers of research in East Africa provide a targeted framework for interventions and collaborations with surgeons and organizations from high-resource settings looking to be involved in global health.
journal_name
Clin Orthop Relat Resjournal_title
Clinical orthopaedics and related researchauthors
Elliott IS,Sonshine DB,Akhavan S,Slade Shantz A,Caldwell A,Slade Shantz J,Gosselin RA,Coughlin RRdoi
10.1007/s11999-015-4254-5subject
Has Abstractpub_date
2015-06-01 00:00:00pages
2120-30issue
6eissn
0009-921Xissn
1528-1132journal_volume
473pub_type
杂志文章abstract:UNLABELLED:The treatment and prognosis of labral tears of the hip depend primarily on whether there is concomitant injury of the adjacent acetabular articular cartilage. We asked whether a delamination cyst on the preoperative plain radiographs correlated with delamination of the acetabular articular cartilage at the t...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999-008-0564-1
更新日期:2009-04-01 00:00:00
abstract::Most studies on shoulder arthroplasty include a diverse group of patients presenting to a tertiary care center. Little information is available regarding outcomes in a community setting. We reviewed 98 residents (110 shoulders) of Olmsted County, Minnesota who had shoulder arthroplasties from 1976 to 2000. There were ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/01.blo.0000238870.99980.64
更新日期:2007-02-01 00:00:00
abstract:BACKGROUND:The importance of spinopelvic motion and its influence on THA stability are well recognized but poorly defined. With dynamic motion, compensatory changes in spine and pelvic positions are required to keep the necessary balance between the axial skeleton and lower extremity to maintain an erect posture. Altho...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/CORR.0000000000000390
更新日期:2019-02-01 00:00:00
abstract:BACKGROUND:Preoperative depressive symptoms have been shown in some but not all studies to be associated with poor self-reported pain and function outcomes. In addition, depressive symptoms after surgery have been shown to improve relative to preoperative levels. QUESTIONS/PURPOSES:We hypothesized that (1) preoperativ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章,多中心研究
doi:10.1007/s11999-015-4203-3
更新日期:2015-11-01 00:00:00
abstract::A review of clinical records and radiographs revealed that five of 10 patients with conjoined twinning (three of six ischiopagus and two of two pyopagus twins) had congenital vertebral anomalies including hemivertebrae (3), multiple thoracic anomalies (1), right hemisacral agenesis (1), and three lumbar vertebra (1). ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/00003086-200012000-00017
更新日期:2000-12-01 00:00:00
abstract::To understand the mechanism of injury and classify fractures of the talus requires knowledge of the anatomy of the hindfoot, its function and the nature of the traumatic forces. The talus has an irregular shape with articular surfaces for tibia, fibula, calcaneus and navicular. It functions as a complex universal join...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1976-11-01 00:00:00
abstract:BACKGROUND:Spinal hardware has been adapted for fixation in the setting of anterior pelvic injury. This anterior subcutaneous pelvic fixator consists of pedicle screws placed in the supraacetabular region connected by a contoured connecting rod placed subcutaneously and above the abdominal muscle fascia. QUESTIONS/PUR...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999-012-2287-6
更新日期:2012-08-01 00:00:00
abstract::Axillary nerve injury remains the most common peripheral nerve injury to affect the shoulder. It most often is seen after glenohumeral joint dislocation, proximal humerus fracture, or a direct blow to the deltoid muscle. Compression neuropathy has been reported to occur in the quadrilateral space syndrome, although th...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章,评审
doi:
更新日期:1999-11-01 00:00:00
abstract::Rupture of the peroneus longus tendon with an associated fracture of the os peroneum is an uncommon injury, which may present as chronic lateral ankle instability. There have been only seven cases documented in the literature since 1966. A case of chronic peroneus longus tendon rupture with os peroneum fracture is pre...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章,评审
doi:10.1097/00003086-199908000-00021
更新日期:1999-08-01 00:00:00
abstract:BACKGROUND:Although gunshot injuries are relatively common, there is little consensus about whether retained bullets or bullet fragments should be removed routinely or only in selected circumstances. QUESTIONS/PURPOSES:We performed a systematic review of the literature to answer the following questions: (1) Is bullet ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章,评审
doi:10.1007/s11999-013-3260-8
更新日期:2013-12-01 00:00:00
abstract:BACKGROUND:The skeleton plays a critical structural role in bearing functional loads, and failure to do so results in fracture. As we evaluate new therapeutics and consider treatments to prevent skeletal fractures, understanding the basic mechanics underlying whole bone testing and the key principles and characteristic...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章,评审
doi:10.1007/s11999-011-1784-3
更新日期:2011-08-01 00:00:00
abstract:BACKGROUND:Although pulsed electromagnetic fields (PEMFs) are used to treat delayed unions and nonunions, their mechanisms of action are not completely clear. However, PEMFs are known to affect the expression of certain genes. QUESTIONS/PURPOSES:We asked (1) whether PEMFs affect gene expression in human osteoblastlike...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999-010-1341-5
更新日期:2010-08-01 00:00:00
abstract::For evaluation of both the anterolateral and posterior approaches to total hip arthroplasty as alternatives to the transtrochanteric approach, 269 replacement procedures in 237 patients were reviewed. Follow-up periods ranged from 24 to 71 months (average, 38.2 months). The anterolateral approach was used in 91 hips, ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1984-09-01 00:00:00
abstract::Ninety-two patients (103 hips) treated with total hip arthroplasty (THA) were assessed before and after operation to determine nutritional status and any correlation with delayed wound healing. Parameters indicative of nutritional status (serum albumin and serum transferrin) were assessed, along with immunologic and a...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1993-08-01 00:00:00
abstract::Marlex mesh is a synthetic material which has been used clinically to replace ligamentous structures. It serves as a scaffold for infiltration of the fibroblasts eventually becoming mature fibrocytes. In dogs, almost totally mature fibrocytes appear within the framework of the Marlex mesh prosthesis by the end of 3 mo...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1978-11-01 00:00:00
abstract::Thirty-six patients (36 shoulders) who underwent the Eden-Hybbinette procedure for recurrent anterior dislocation of the shoulder with an average followup of 15 years were evaluated. Evaluation consisted of radiographic assessment in a true anteroposterior view and an axillary lateral view of both shoulders, physical ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/00003086-200004000-00016
更新日期:2000-04-01 00:00:00
abstract::By the time a patient's shoulder problem has reached the stage in which an arthrodesis is being considered, the patient usually is willing to accept the restraints of an arthrodesed shoulder. If there is a chance of relieving chronic pain and restoring some reasonable degree of function in the upper extremity, arthrod...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1983-03-01 00:00:00
abstract::Quality of life measures have neglected to include a critical self-assessment component in pediatric sarcoma patients. Our report shows how children rate their own quality of life and how that varies over time after surgery. Using the Pediatric Outcomes Data Collection Instrument, quality of life data was prospectivel...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/BLO.0b013e31804f545d
更新日期:2007-06-01 00:00:00
abstract::With the use of a stereoscopic microscope, observations were made on the course of the proper digital nerve of the thumb on ten upper limbs in adult cadavers. By observation from the dorsal side after removal of the bone, it was possible to clearly see the ramification of the digital nerve from the subcutaneous tissue...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1985-09-01 00:00:00
abstract::Bisphosphonate treatment has been shown to decrease endosteal bone formation and increase periosteal bone apposition in the rat tibial diaphysis. This study tested the hypothesis that the increase in periosteal apposition is a compensatory attempt to maintain skeletal mass appropriate for the mechanical load. Twenty-f...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1992-05-01 00:00:00
abstract::Multimodal, limb-saving therapy is the treatment of choice in children with osteosarcoma. However, few data are available on long-term functional problems and disabilities in surviving patients. Seventy-eight children treated for Stage II-B osteosarcoma who were treated between 1970 and 1997 were evaluated. Beyond the...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:2004-04-01 00:00:00
abstract::The major problem in osteoarthritis research today is our inability to promote effective cartilage regeneration in the presence of adult chondromalacia. Yet such regeneration is consistently present in acromegalics. The present study of experimentally damaged rabbit knee cartilage measures numbers of cells, mitoses, t...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1975-01-01 00:00:00
abstract:BACKGROUND:Patients with a patient-reported penicillin allergy may be at greater risk for postoperative prosthetic joint infection (PJI) after total joint arthroplasty of the hip, knee, or shoulder. The increased risk of PJI in these patients has been attributed to these patients receiving a less-effective perioperativ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/CORR.0000000000001497
更新日期:2020-12-01 00:00:00
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journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999-010-1508-0
更新日期:2011-02-01 00:00:00
abstract:BACKGROUND:Osteochondral allografting is an option for successful treatment of large articular cartilage defects. Use of osteochondral allografting is limited by graft availability, often because of loss of chondrocyte viability during storage. QUESTIONS/PURPOSES:The purpose of this study was to compare osteochondral ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999-014-3773-9
更新日期:2014-11-01 00:00:00
abstract::Nineteen patients had a severe neurologic deficit and persistent dysesthetic pain after total hip replacement. During surgery their limbs had been lengthened by 1.3 to 4.1 cm. Patients with other reasons for nerve injury such as hematoma, dislocation, or direct operative trauma were excluded. Also excluded were patien...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/00003086-200401000-00027
更新日期:2004-01-01 00:00:00
abstract::The skeletal system manifestations of thalassemia are characterized by severe osteoporosis, frequent fractures and delayed healing. Permanent deformity and disability can complicate the fractures. Surgical correction of deformity by osteotomy of severely osteoporotic bone and immobilization without internal fixation w...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1978-09-01 00:00:00
abstract::We questioned whether our current preoperative demand matching accurately predicted patient activity after TKA. From a prospective database we reviewed 511 patients who had unilateral, primary TKA from 1994 to 1999 and who were preoperatively assessed for five patient characteristics: age, weight, expected postoperati...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/01.blo.0000229361.12244.2d
更新日期:2006-11-01 00:00:00
abstract::To investigate the role of blood supply in the pathogenesis of idiopathic osteonecrosis of the femoral head, superselective angiography of the medial circumflex artery was performed. Sixteen hips with early stage osteonecrosis diagnosed by bone scintigraphy were studied, as were 22 contralateral normal hips (from unil...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1992-04-01 00:00:00
abstract:BACKGROUND:Hip fractures are a major public health concern. For displaced femoral neck fractures, the needs for medical services during hospitalization and extending beyond hospital discharge after total hip arthroplasty (THA) may be different than the needs after THA performed for osteoarthritis (OA), yet these differ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999-016-4868-2
更新日期:2017-02-01 00:00:00