No abstract

Background A new technique to obtain the sensory nerve action potential (SNAP) of the medial femoral cutaneous nerve is described. Methods SNAPs were recorded from 104 subjects with a bar recording electrode 10 cm proximal to the patella along an imaginary line drawn between the medial edge of the patella and the femoral pulse below the inguinal ligament. Stimulation was applied 14 cm proximal to the recording point. Results There were 104 healthy subjects. Onset latency of the SNAPs was 2.20 ± 0.16 ms (mean ± SD), peak latency was 2.70 ± 0.16 ms, peak‐to‐peak amplitude was 7.5 ± 3.0 μV, and conduction velocity was 51.5 ± 3.0 m/s. The side‐to‐side difference in the mean amplitude was 22.27 ± 13.6%. Conclusions This new technique is easy, reliable, and reproducible, and should prove useful for the evaluation of neuropathies of the medial femoral cutaneous nerve.

Background and AimKnowledge translation processes are necessary for improving patients' and communities' health outcomes. The aim of this study was to systematically develop evidence-based recommendations for people over 16 years of age who are in risk for or have suffered a lower limb amputation for medical reasons (vascular, diabetes mellitus) or trauma (civilian or military trauma) in order to improve function, quality of life, decrease complications and morbidity.MethodsFollowing the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach we developed a Clinical Practice Guideline (CPG) for lower limb amputees with funding from the Ministry of Health in Colombia and participation of a multidisciplinary group. We included patients' preferences. Based on the scope, purposes and objectives the questions were elaborated with the PECOT strategy. The evidence search was performed for each question in the main databases: Cochrane Library, Embase and PubMed, without time limit or language restriction. Teams were formed with thematic experts and clinical epidemiologists to review the clinical studies, describe the evidence, and evaluate the quality of the body of evidence with the GRADE methodology. The recommendations were made according to the judgments proposed by the GRADE working group. We conducted a stakeholder's dialogue as a mechanism for the external validation of the guideline implementation.ResultsThe CPG included 43 recommendations related to the diagnosis, surgical treatment, rehabilitation, prescription and adaptation of the prosthesis. They were strong in favor 37.2, weak in favor 53.5, strong against 2.3, Weak against 7.0%. Quality of evidence was high in 0, moderate in 11.6, low in 58.1, and very low 30.2%.DiscussionIn 93% of the recommendations, the quality of the evidence was between low and very low. This is why it was so important to validate and discuss each recommendation with an expanded multidisciplinary group. The research group identified 25 interventions and five milestones to be prioritized in the implementation and in the stakeholder's dialogue participants identified opportunities and barriers for implementation of recommendations.ConclusionIt is necessary to develop a national policy for implementation strategies of CPG recommendations that promotes the necessary arrangements for the provision of services for diagnosis, treatment, and rehabilitation of individuals with amputations.

Objective The purpose of this study was to develop and validate a questionnaire to identify the perceived barriers in the implementation of the Clinical Practice Guidelines for the lower limb amputee (CPGAMP). Study design and setting: The study consisted of two stages: first, the development of the questionnaire based on a meta-review of the literature and interviews with patients and health providers. Second, the evaluation of its psychometric properties was performed. Participants included health providers from hospitals and clinics, prosthetic workshops, and academic institutions in Colombia. Results A total of 90 items were obtained from the literature review and interviews. Validation of a preliminary 66-item questionnaire was performed with 545 participants. After the factorial analysis a 25-item questionnaire with four domains was developed. Internal consistency was adequate in the four domains, with Cronbach's alpha values between 0.76 and 0.83. Test-retest reliability in 58 participants yielded intraclass correlation coefficients between 0.51 and 0.59. Conclusions A 25-item questionnaire with four domains (health system; guidelines; institutional and individual) was proposed to measure the perception of barriers to the CPGAMP. The conceptual framework and the questionnaire can be used to identify barriers of other CPG and to help design strategies aimed at improving its implementation.

No abstract