Browsing by Author "Diaz-Ledezma, Claudio"
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- ItemAn international consensus based on the Delphi method to define failure of medical treatment in pyogenic spinal infections(2024) Urrutia, Julio; Camino-Willhuber, Gaston; Guerrero, Alonso; Diaz-Ledezma, Claudio; Bono, Christopher M.BACKGROUND CONTEXT: Pyogenic spinal infections (PSIs) are severe conditions with high morbidity and mortality. If medical treatment fails, patients may require surgery, but there is no consensus regarding the definition of medical treatment failure. PURPOSE: To determine criteria for defining failure of medical treatment in PSI through an international consensus of experts. STUDY DESIGN: A two -round basic Delphi method study. SAMPLE: One hundred and fifty experts from 22 countries (authors or co-authors of clinical guidelines or indexed publications on the topic) were invited to participate; 33 answered both rounds defining the criteria. OUTCOME MEASURES: A scale of 1 to 9 (1: no relevance; 9: highly relevant) applied to each criterion. METHODS: We created an online survey with 10 criteria reported in the literature to define the failure of medical treatment in PSIs. We sent this survey via email to the experts. Agreement among the participants on relevant criteria (score >= 7) was determined. One month later, the second round of evaluations was sent. An extra criterion suggested by six responders in the first round was incorporated. The final version was reached with the criteria considered relevant and with high agreement. RESULTS: The consensus definition is: (1) There is an uncontrolled sepsis despite broad spectrum antibiotic treatment, and (2) There is an infection relapse, following a six -week period of antibiotics with clinical and laboratory improvement. CONCLUSIONS: Our definition of failure following nonsurgical treatment of PSI can offer a standardized approach to guide clinical decision -making. Furthermore, it has the potential to enhance scientific reporting within this field. (c) 2023 Elsevier Inc. All rights reserved.
- ItemInter- and intra-observer agreement using the new AOSpine sacral fracture classification, with a comparison between spine and pelvic trauma surgeons(2022) Meissner-Haecker, Arturo; Diaz-Ledezma, Claudio; Klaber, Ianiv; Zamora, Tomas; Valencia, Manuel; Camino-Willhuber, Gaston; Astur, Nelson; Yurac, Ratko; Valacco, Marcelo; Urrutia, JulioBackground: Sacral fractures treatment frequently involves both spine and pelvic trauma surgeons; therefore, a consistent communication among surgical specialists is required. We independently assessed the new AOSpine sacral fracture classification's agreement from the perspective of spine and pelvic trauma surgeons. Methods: Complete computerized tomography (CT) scans of 80 patients with sacral fractures were selected and classified using the new AOSpine sacral classification system by six spine surgeons and three pelvic trauma surgeons. After four weeks, the 80 cases were presented and reassessed by the same raters in a new random sequence. The Kappa coefficient ( K) was used to measure the inter-and intra-observer agreement. Results: The inter-observer agreement considering the fracture severity types (A, B, or C) was substantial for spine surgeons ( K= 0.68 [0.63 - 0.72]) and pelvic trauma surgeons ( K= 0.74 (0.64 - 0.84). Regarding the subtypes, both groups achieved moderate agreement with K= 0.52 (0.49 - 0.54) for spine surgeons and K= 0.51 (0.45 - 0.57) for pelvic trauma surgeons. The intra-observer agreement considering the fracture types was substantial for spine surgeons ( K= 0.74 [0.63 - 0.75]) and almost perfect for pelvic trauma surgeons ( K= 0.84 [0.74 - 0.93]). Concerning the subtypes, both groups achieved substantial agreement with, K= 0.61 (0.56 - 0.67) for spine surgeons and K= 0.68 (0.62 - 0.74) for pelvic trauma surgeons. Conclusion: This classification allows an adequate communication for spine surgeons and pelvic trauma surgeons at the fracture severity type, but the agreement is only moderate at the subtype level. Future prospective studies are required to evaluate whether this classification allows for treatment recommendations and establishing prognosis in patients with sacral fractures. @ 2021 Elsevier Ltd. All rights reserved.
- ItemThe impact of lumbar scoliosis on pain, function and health-related quality of life in postmenopausal women(2011) Urrutia, Julio; Espinosa, Julio; Diaz-Ledezma, Claudio; Cabello, CarlosThe impact of adult scoliosis on pain, function and health-related quality of life (QOL) has not been clearly defined. A population-based study using widely applied screening tools could better reflect the impact of adult scoliosis. In this study, a visual analog pain scale assessment (VAS) for lumbar and leg pain, an Oswestry disability index (ODI) and a standard version of the Medical Outcome Study Short Form-36 (SF-36) questionnaire were sent by mail to 261 women of age 50 years and older, consecutively evaluated with dual-energy radiograph absorptiometry (DXA) scan images. 138 patients (32 with lumbar curves 10A degrees or bigger) returned the questionnaires. Differences in lumbar VAS, leg VAS, ODI and SF-36 values between groups of patients with curves < 10A degrees, 10A degrees-19A degrees and a parts per thousand yen20A degrees were evaluated. Correlation analyses of the Cobb angle, age and body mass index (BMI) with VAS, ODI and SF-36 values, and multivariate regression analysis were performed. Patients with curves < 10A degrees, 10A degrees aEuro"19A degrees and a parts per thousand yen20A degrees had no significant differences in lumbar or leg VAS, ODI or SF-36 values. ODI values correlated with age and BMI; SF-36 values correlated with BMI only; lumbar and leg VAS values did not correlate with lumbar curvature, age or BMI. Regression disclosed that Cobb angle values did not influence ODI, SF-36 or VAS values. In postmenopausal women with mild and moderate lumbar curves, Cobb angle had no influence on pain, function and QOL; age and BMI had small effect.