PeerJ Preprints: Evidence Based Medicinehttps://peerj.com/preprints/index.atom?journal=peerj&subject=4500Evidence Based Medicine articles published in PeerJ PreprintsPractical considerations for collaborative research between the pharmaceutical industry and external investigatorshttps://peerj.com/preprints/277852019-06-052019-06-05Maureen LloydCynthia K BarbitschMary Voehl HirschAntonia PanayiEric Southam
Traditionally, clinical research has been conducted via either industry sponsored studies or non-industry investigator sponsored studies. Collaborative Research provides a relatively new mechanism for industry and non-industry partners to work together in the pursuit of effective and safe treatments for the patient. The aims of this article are to provide both industry and non-industry investigators with a greater insight into the complex processes that are currently employed by industry when entering into Collaborative Research agreements, and to encourage consistency and transparency in approach across companies.
In Collaborative Research, instead of being limited to providing funding and/or product, the industry partner contributes expertise complementary to that of the non-industry partner, who is the sponsor of the study. Collaborative Research may be conducted before, during or after regulatory approval of a drug or medical device, and may be interventional, observational or preclinical.
A collaboration requires appropriate process and governance frameworks to be established in order to be successful. Important considerations include the routes for submitting a request, the review and approval process, due diligence criteria, budgeting and contracting processes, permissible interactions during the execution of the research, the closing out of the research, and dispute resolution. It is also necessary to have in place an agreed communication strategy and a risk control framework. Clear and specific contract language around roles and responsibilities, intellectual property, rights to data, registration and disclosure of publications, and an understanding of adverse event reporting procedures are other critical facets of Collaborative Research that are essential to avoid delays and disputes.
With no global standards for Collaborative Research, it is important that partners establish practical procedures, good ongoing communication, alignment of goals, and transparent interactions and disclosure to jointly advance the science of new, safe and effective therapies.
Traditionally, clinical research has been conducted via either industry sponsored studies or non-industry investigator sponsored studies. Collaborative Research provides a relatively new mechanism for industry and non-industry partners to work together in the pursuit of effective and safe treatments for the patient. The aims of this article are to provide both industry and non-industry investigators with a greater insight into the complex processes that are currently employed by industry when entering into Collaborative Research agreements, and to encourage consistency and transparency in approach across companies.In Collaborative Research, instead of being limited to providing funding and/or product, the industry partner contributes expertise complementary to that of the non-industry partner, who is the sponsor of the study. Collaborative Research may be conducted before, during or after regulatory approval of a drug or medical device, and may be interventional, observational or preclinical.A collaboration requires appropriate process and governance frameworks to be established in order to be successful. Important considerations include the routes for submitting a request, the review and approval process, due diligence criteria, budgeting and contracting processes, permissible interactions during the execution of the research, the closing out of the research, and dispute resolution. It is also necessary to have in place an agreed communication strategy and a risk control framework. Clear and specific contract language around roles and responsibilities, intellectual property, rights to data, registration and disclosure of publications, and an understanding of adverse event reporting procedures are other critical facets of Collaborative Research that are essential to avoid delays and disputes.With no global standards for Collaborative Research, it is important that partners establish practical procedures, good ongoing communication, alignment of goals, and transparent interactions and disclosure to jointly advance the science of new, safe and effective therapies.PICO and Risk Of bias Navigator for Evidence Based Medicinehttps://peerj.com/preprints/276842019-06-022019-06-02Tomohide YamadaYoshinobu KondoRyo Momosaki
Evidence-based medicine (EBM) involves determining treatment that matches the needs of each patient by integrating the best and latest available “scientific evidence” and “clinical skills”. Systematic review and meta-analysis refer to the process of searching databases and performing statistical analysis to integrate the results of multiple independent studies conducted in the past. The results obtained provide the highest quality evidence, which has become the foundation of various clinical guidelines. Systematic review and meta-analysis are conducted in the following sequence: 1) formulation of a hypothesis, 2) searching databases for articles, 3) selection of research articles, 4) evaluation of bias for each study, 5) integration of the results, 6) verification of bias, and 7) evaluation of the quality of the meta-analysis. Especially regarding 2) article searches and 3) article selection, it is usual for two or more researchers to independently conduct a comprehensive search of databases and extract all the articles that meet the eligibility criteria. Generally, each researcher must evaluate thousands of research articles one by one, making the whole process very time-consuming. In addition, articles may be missed since the search is done manually, and the results tend to be arbitrary. Moreover, updating the information requires a lot of time and effort. Generally, it takes one to two years to complete a single systematic review and meta-analysis. As a result, many reviews are obsolete or missing. Therefore, development of software that could contribute to labor saving and automation of systematic review has been advocated. PICORON-EBM aims to shorten the time required for assessment of PICO and Risk of Bias by natural language processing. Strengths: 1. Quick and Easy operation. 2. You can add and delete any keywords to your area of interest.
URL: http://www.picoron.com/
Evidence-based medicine (EBM) involves determining treatment that matches the needs of each patient by integrating the best and latest available “scientific evidence” and “clinical skills”. Systematic review and meta-analysis refer to the process of searching databases and performing statistical analysis to integrate the results of multiple independent studies conducted in the past. The results obtained provide the highest quality evidence, which has become the foundation of various clinical guidelines. Systematic review and meta-analysis are conducted in the following sequence: 1) formulation of a hypothesis, 2) searching databases for articles, 3) selection of research articles, 4) evaluation of bias for each study, 5) integration of the results, 6) verification of bias, and 7) evaluation of the quality of the meta-analysis. Especially regarding 2) article searches and 3) article selection, it is usual for two or more researchers to independently conduct a comprehensive search of databases and extract all the articles that meet the eligibility criteria. Generally, each researcher must evaluate thousands of research articles one by one, making the whole process very time-consuming. In addition, articles may be missed since the search is done manually, and the results tend to be arbitrary. Moreover, updating the information requires a lot of time and effort. Generally, it takes one to two years to complete a single systematic review and meta-analysis. As a result, many reviews are obsolete or missing. Therefore, development of software that could contribute to labor saving and automation of systematic review has been advocated. PICORON-EBM aims to shorten the time required for assessment of PICO and Risk of Bias by natural language processing. Strengths: 1. Quick and Easy operation. 2. You can add and delete any keywords to your area of interest.URL: http://www.picoron.com/Automated data extraction software for medical summary using text mining (T-Library)https://peerj.com/preprints/276852019-06-022019-06-02Tomohide YamadaYoshinobu KondoRyo Momosaki
The electronic medical record (EMR) is a source of clinical information and is used for clinical research. Clinical researchers leverage this information by employing staffs to manually extracting data from the unstructured text. This process can be both error-prone and labor-intensive.
This software (T-Library) is a software which automatically extracts key clinical data from patient records and can potentially help healthcare providers and researchers save money, make treatment decisions and manage clinical trials.
This software saves labor for data transcription in clinical research. This is a vital step toward getting researchers rapid access to the information they need. This is also the attempt to cluster patients’ morbid states and establish accurate and constantly updated risk engine of complications’ crises, using deep learning.
Strengths: 1) Quick and Easy operation
URL: http://www.picoron.com/tlibrary/
The electronic medical record (EMR) is a source of clinical information and is used for clinical research. Clinical researchers leverage this information by employing staffs to manually extracting data from the unstructured text. This process can be both error-prone and labor-intensive.This software (T-Library) is a software which automatically extracts key clinical data from patient records and can potentially help healthcare providers and researchers save money, make treatment decisions and manage clinical trials.This software saves labor for data transcription in clinical research. This is a vital step toward getting researchers rapid access to the information they need. This is also the attempt to cluster patients’ morbid states and establish accurate and constantly updated risk engine of complications’ crises, using deep learning.Strengths: 1) Quick and Easy operationURL: http://www.picoron.com/tlibrary/Catheter ablation vs antiarrhythmic medication in atrial fibrillationhttps://peerj.com/preprints/277692019-05-302019-05-30Eric W ManheimerMartin MayerBrian S Alper
The CABANA and CAPTAF trials report more data on the effects of catheter ablation vs. antiarrhythmic medication on quality of life for patients with atrial fibrillation than previously available systematic reviews. However, these publications do not report data for all-cause mortality and cardiac hospitalization in a form that can be integrated into recent meta-analyses.
Recent meta-analysis estimates for the effect of catheter ablation on all-cause mortality suggest a reduction in patients with comorbid heart failure with reduced ejection fraction (HFrEF) (risk ratio [RR] 0.52, 95% CI 0.33 to 0.81, n=732, 5 trials) and an unclear effect in patients without comorbid HFrEF (RR 0.88, 95% CI 0.29 to 2.61, n=710, 4 trials).
CABANA (n = 2,204) reported mortality for all patients combined (hazard ratio 0.86, 95% CI 0.65 to 1.15), and subgroup analyses by presence or absence of HFrEF would be useful to determine consistency with other trials and, if consistent, increase precision of pooled effect estimates. CAPTAF (n = 155) (which included almost exclusively patients without comorbid heart failure) did not report the mortality outcome data.
Both trials collected data on cardiac hospitalization. A recent meta-analysis suggests a reduction in cardiac hospitalization in patients with comorbid HFrEF (RR 0.63, 95% CI 0.46 to 0.87, n=632, 3 trials) and in patients without comorbid HFrEF (RR 0.32, 95% CI 0.23 to 0.45, n=629, 4 trials). Again, however, the CABANA and CAPTAF trials did not report these data in a way that would allow them to be integrated into existing meta-analyses or did not report these data at all. Reporting key clinical outcomes from these trials with subgrouping by comorbid HFrEF could provide substantially more data than the prior body of evidence and inform best current estimates for this comparison.
The CABANA and CAPTAF trials report more data on the effects of catheter ablation vs. antiarrhythmic medication on quality of life for patients with atrial fibrillation than previously available systematic reviews. However, these publications do not report data for all-cause mortality and cardiac hospitalization in a form that can be integrated into recent meta-analyses.Recent meta-analysis estimates for the effect of catheter ablation on all-cause mortality suggest a reduction in patients with comorbid heart failure with reduced ejection fraction (HFrEF) (risk ratio [RR] 0.52, 95% CI 0.33 to 0.81, n=732, 5 trials) and an unclear effect in patients without comorbid HFrEF (RR 0.88, 95% CI 0.29 to 2.61, n=710, 4 trials).CABANA (n = 2,204) reported mortality for all patients combined (hazard ratio 0.86, 95% CI 0.65 to 1.15), and subgroup analyses by presence or absence of HFrEF would be useful to determine consistency with other trials and, if consistent, increase precision of pooled effect estimates. CAPTAF (n = 155) (which included almost exclusively patients without comorbid heart failure) did not report the mortality outcome data.Both trials collected data on cardiac hospitalization. A recent meta-analysis suggests a reduction in cardiac hospitalization in patients with comorbid HFrEF (RR 0.63, 95% CI 0.46 to 0.87, n=632, 3 trials) and in patients without comorbid HFrEF (RR 0.32, 95% CI 0.23 to 0.45, n=629, 4 trials). Again, however, the CABANA and CAPTAF trials did not report these data in a way that would allow them to be integrated into existing meta-analysesor did not report these data at all. Reporting key clinical outcomes from these trials with subgrouping by comorbid HFrEF could provide substantially more data than the prior body of evidence and inform best current estimates for this comparison.Characteristics of effective home-based resistance training exercise in patients with chronic disease: a scoping review protocolhttps://peerj.com/preprints/276792019-04-242019-04-24Thomas WilkinsonRoseanne BillanyCourtney J LightfootMatthew Graham-BrownAlice C Smith
Regular exercise, principally resistance training, is an effective method to promote muscle hypertrophy and attenuate muscle atrophy during various atrophic conditions . There is growing interest in the evaluation of home-based resistance training programmes. These programmes have the potential to overcome common barriers to participation, such as accessibility and affordability. The objective of the scoping review is to map the available evidence to provide an overview of what characteristics, principles, and components are required for an effective home-based resistance training programme in patients with chronic disease. The four specific objectives of the scoping review will be to: 1) conduct a systematic search of the published and grey literature for studies reporting on home-based resistance training in patients with chronic disease; 2) map out the characteristics and range of methodologies (including exercise protocols and outcome measures) used in effective home-based resistance training; 3) examine reported challenges and limitations of home-based resistance training; and 4) propose recommendations for optimizing home-based resistance training protocols in this population.
Regular exercise, principally resistance training, is an effective method to promote muscle hypertrophy and attenuate muscle atrophy during various atrophic conditions . There is growing interest in the evaluation of home-based resistance training programmes. These programmes have the potential to overcome common barriers to participation, such as accessibility and affordability. The objective of the scoping review is to map the available evidence to provide an overview of what characteristics, principles, and components are required for an effective home-based resistance training programme in patients with chronic disease. The four specific objectives of the scoping review will be to: 1) conduct a systematic search of the published and grey literature for studies reporting on home-based resistance training in patients with chronic disease; 2) map out the characteristics and range of methodologies (including exercise protocols and outcome measures) used in effective home-based resistance training; 3) examine reported challenges and limitations of home-based resistance training; and 4) propose recommendations for optimizing home-based resistance training protocols in this population.Novel citation-based search method for scientific literature: a validation studyhttps://peerj.com/preprints/276462019-04-112019-04-11Cecile JanssensMarta GwinnJ. Elaine BrockmanKimberley PowellMichael Goodman
Objective: We recently developed CoCites, a citation-based search method that is designed to be more efficient than traditional keyword-based methods. The method begins with identification of one or more highly relevant publications (query articles) and consists of two searches: the co-citation search, which ranks publications on their co-citation frequency with the query articles, and the citation search, which ranks publications on frequency of all citations that cite or are cited by the query articles. Materials and Methods: We aimed to reproduce the literature searches of published systematic reviews and meta-analyses (n=250) and assess whether CoCites retrieves all eligible articles while screening fewer titles. Results: CoCites retrieved a median of 75% of the articles that were included in the original reviews. The percentage of retrieved articles was higher (88%) when the query articles were cited more frequently and when they had more overlap in their citations. Applying CoCites to only the highest-cited article yielded similar results. The co-citation and citation searches combined were more efficient when the review authors had screened more than 500 titles, but not when they had screened less. Discussion: CoCites uses the expert knowledge of authors to rank related articles. The method does not depend on keyword selection and requires no special expertise to build search queries. The method is transparent and reproducible. Conclusion: CoCites is an efficient and accurate method for finding relevant related articles.
Objective: We recently developed CoCites, a citation-based search method that is designed to be more efficient than traditional keyword-based methods. The method begins with identification of one or more highly relevant publications (query articles) and consists of two searches: the co-citation search, which ranks publications on their co-citation frequency with the query articles, and the citation search, which ranks publications on frequency of all citations that cite or are cited by the query articles. Materials and Methods: We aimed to reproduce the literature searches of published systematic reviews and meta-analyses (n=250) and assess whether CoCites retrieves all eligible articles while screening fewer titles. Results: CoCites retrieved a median of 75% of the articles that were included in the original reviews. The percentage of retrieved articles was higher (88%) when the query articles were cited more frequently and when they had more overlap in their citations. Applying CoCites to only the highest-cited article yielded similar results. The co-citation and citation searches combined were more efficient when the review authors had screened more than 500 titles, but not when they had screened less. Discussion: CoCites uses the expert knowledge of authors to rank related articles. The method does not depend on keyword selection and requires no special expertise to build search queries. The method is transparent and reproducible. Conclusion: CoCites is an efficient and accurate method for finding relevant related articles.Exploring the health informatics occupational group in the 2018 Australian health information workforce censushttps://peerj.com/preprints/276262019-04-022019-04-02Kerryn Butler-HendersonKathleen GrayChristopher PearceAnn RitchieJulie BrophyLouise K SchaperVicki BennettAngela Ryan
There has been no empirical evidence about the health informatics workforce in Australia produced in the last ten years. This study reports the findings from an analysis of a subset of the 2018 Australian Health Informatics Workforce Census data. Analysing 420 responses that were identified as the occupational group Health Informatics, the results indicate that whilst most of the workforce is classified as aged (>45 years), many respondents are still relatively early in their health informatics careers. Furthermore, most do not possess any formal education in health informatics and almost a quarter undertake their health informatics role alongside another health-related role. The broad range of position titles and functions demonstrates the breadth within this workforce. Ongoing monitoring of this occupational group is required to inform workforce reform and renewal.
There has been no empirical evidence about the health informatics workforce in Australia produced in the last ten years. This study reports the findings from an analysis of a subset of the 2018 Australian Health Informatics Workforce Census data. Analysing 420 responses that were identified as the occupational group Health Informatics, the results indicate that whilst most of the workforce is classified as aged (>45 years), many respondents are still relatively early in their health informatics careers. Furthermore, most do not possess any formal education in health informatics and almost a quarter undertake their health informatics role alongside another health-related role. The broad range of position titles and functions demonstrates the breadth within this workforce. Ongoing monitoring of this occupational group is required to inform workforce reform and renewal.The effects of a 4-week mesocycle of barbell back squat or barbell hip thrust strength training upon isolated lumbar extension strengthhttps://peerj.com/preprints/275992019-03-182019-03-18Alexander HammondCraig PerrinJames SteeleJürgen GiessingPaulo GentilJames P Fisher
Objectives: Common exercises such as the barbell back squat (BBS) and barbell hip thrust (BHT) are perceived to provide a training stimulus to the lumbar extensors. However, to date there have been no empirical studies considering changes in lumbar extension strength as a result of BBS or BHT resistance training interventions. Purpose: To consider the effects of barbell back squat (BBS) and barbell hip thrust (BHT) resistance training programmes upon isolated lumbar extension (ILEX) strength. Methods: Trained male subjects (n=14; 22.07 ± 0.62 years; 179.31 ± 6.96 cm; 79.77 ± 13.81 kg) were randomised in to either BBS (n=7) or BHT (n=7) groups and performed 2 training sessions per week during a 4-week mesocycle using 80% of their 1RM. All subjects were tested pre- and post-intervention for BBS and BHT 1RM as well as isometric ILEX strength. Results: Analyses revealed that both BBS and BHT groups significantly improved both their BBS and BHT 1RM, suggesting a degree of transferability. However, the BBS group improved their BBS 1RM to a greater degree than the BHT group (p=0.050; ~11.8kg/10.2% vs. ~8.6kg/7.7%, respectively). And the BHT group improved their BHT 1RM to a greater degree than the BBS group (p=0.034; ~27.5kg/24.8% vs. ~20.3kg/13.3%, respectively). Neither BBS nor BHT groups significantly improved their isometric ILEX strength. Conclusions: The present study supports the concept of specificity, particularly in relation to the movement mechanics between trunk extension (including pelvic rotation) and ILEX. Our data suggests that strength coaches personal trainers, and trainees can self-select multi-joint lower body trunk extension exercises based on preference or variety. However, evidence suggests that neither the BBS nor BHT exercises can meaningfully increase isolated lumbar extension strength. Since strengthening these muscles might enhance physical and sporting performance we encourage strength coaches and personal trainers to prescribe ILEX exercise.
Objectives: Common exercises such as the barbell back squat (BBS) and barbell hip thrust (BHT) are perceived to provide a training stimulus to the lumbar extensors. However, to date there have been no empirical studies considering changes in lumbar extension strength as a result of BBS or BHT resistance training interventions. Purpose: To consider the effects of barbell back squat (BBS) and barbell hip thrust (BHT) resistance training programmes upon isolated lumbar extension (ILEX) strength. Methods: Trained male subjects (n=14; 22.07 ± 0.62 years; 179.31 ± 6.96 cm; 79.77 ± 13.81 kg) were randomised in to either BBS (n=7) or BHT (n=7) groups and performed 2 training sessions per week during a 4-week mesocycle using 80% of their 1RM. All subjects were tested pre- and post-intervention for BBS and BHT 1RM as well as isometric ILEX strength. Results: Analyses revealed that both BBS and BHT groups significantly improved both their BBS and BHT 1RM, suggesting a degree of transferability. However, the BBS group improved their BBS 1RM to a greater degree than the BHT group (p=0.050; ~11.8kg/10.2% vs. ~8.6kg/7.7%, respectively). And the BHT group improved their BHT 1RM to a greater degree than the BBS group (p=0.034; ~27.5kg/24.8% vs. ~20.3kg/13.3%, respectively). Neither BBS nor BHT groups significantly improved their isometric ILEX strength. Conclusions: The present study supports the concept of specificity, particularly in relation to the movement mechanics between trunk extension (including pelvic rotation) and ILEX. Our data suggests that strength coaches personal trainers, and trainees can self-select multi-joint lower body trunk extension exercises based on preference or variety. However, evidence suggests that neither the BBS nor BHT exercises can meaningfully increase isolated lumbar extension strength. Since strengthening these muscles might enhance physical and sporting performance we encourage strength coaches and personal trainers to prescribe ILEX exercise.Health information work - a scoping review protocolhttps://peerj.com/preprints/275352019-02-152019-02-15Kathleen M GrayCecily A Gilbert
Background: The work of managing health data, health information or health knowledge is a vital, yet unacknowledged, function in our current health system. This protocol is for a literature review which explores the evolution and development of the concept of health information work. Methodology: A scoping review of published literature in the domains of health sciences, information technology and information sciences has been carried out. A thematic and bibliometric analysis of the resulting set of publications is currently being undertaken. Results: The review results will shed light on the responsibilities and the contribution of the health information workforce, with a synthesis of themes identified in the literature, and analysis of publication year spans, prominent authors, institutions and source journals.
Background: The work of managing health data, health information or health knowledge is a vital, yet unacknowledged, function in our current health system. This protocol is for a literature review which explores the evolution and development of the concept of health information work. Methodology: A scoping review of published literature in the domains of health sciences, information technology and information sciences has been carried out. A thematic and bibliometric analysis of the resulting set of publications is currently being undertaken. Results: The review results will shed light on the responsibilities and the contribution of the health information workforce, with a synthesis of themes identified in the literature, and analysis of publication year spans, prominent authors, institutions and source journals.A protocol for a survey of patient perceptions about outpatient joint replacement surgery (The RAAPID survey)https://peerj.com/preprints/274642019-01-032019-01-03Taylor WoolnoughKim MaddenAnthony AdiliVickas KhannaJustin deBeerMitchell WinemakerThomas WoodDaniel Tushinski
Background: Total knee arthroplasty (TKA) and total hip arthroplasty (THA), are the second and third most common surgical procedures performed in Canada, accounting for more than 600,000 acute care bed days and over $1 billion CAD in healthcare spending. The demand for these procedures, both in Canada and internationally, is only expected to increase. Same-day discharge has been demonstrated to be safe and effective in properly selected patients and has the potential to greatly decrease the cost of THA and TKA, collectively referred to as total joint arthroplasty (TJA). The existing literature focuses on implementing outpatient TJA from the physician’s perspective. However, patient opinions do not always align with physician opinions. To date, only one study has explored patients’ perspectives regarding outpatient TJA; many questions remain unanswered. To effectively implement or expand outpatient joint replacement programs, detailed exploration of the patient perspective is necessary.
Methods: This study is a multicentre cross-sectional survey to primarily determine the proportion of patients who are open to outpatient TJA. Adult patients scheduled for primary TJA surgery or those who have received TJA surgery in the past year will be included in the survey. The secondary objectives of this survey are to determine patient characteristics associated with openness to outpatient TJA, describe patient concerns regarding outpatient TJA, and identify potential methods to increase patient comfort with outpatient TJA.
Discussion: Resource expenditure and clinical practice are increasingly guided by subjective patient outcomes, especially in the area of joint replacement. With the current focus on cost-efficiency in healthcare, there is increasing interest in outpatient TJA. By exploring how patients perceive outpatient TJA, this study may serve to guide the development of educational resources and programs to enhance and support outpatient TJA. Addressing concerns identified by patients in an evidence-based manner has the potential to improve patient satisfaction and outcomes in the growing trend of outpatient TJA.
Background: Total knee arthroplasty (TKA) and total hip arthroplasty (THA), are the second and third most common surgical procedures performed in Canada, accounting for more than 600,000 acute care bed days and over $1 billion CAD in healthcare spending. The demand for these procedures, both in Canada and internationally, is only expected to increase. Same-day discharge has been demonstrated to be safe and effective in properly selected patients and has the potential to greatly decrease the cost of THA and TKA, collectively referred to as total joint arthroplasty (TJA). The existing literature focuses on implementing outpatient TJA from the physician’s perspective. However, patient opinions do not always align with physician opinions. To date, only one study has explored patients’ perspectives regarding outpatient TJA; many questions remain unanswered. To effectively implement or expand outpatient joint replacement programs, detailed exploration of the patient perspective is necessary.Methods: This study is a multicentre cross-sectional survey to primarily determine the proportion of patients who are open to outpatient TJA. Adult patients scheduled for primary TJA surgery or those who have received TJA surgery in the past year will be included in the survey. The secondary objectives of this survey are to determine patient characteristics associated with openness to outpatient TJA, describe patient concerns regarding outpatient TJA, and identify potential methods to increase patient comfort with outpatient TJA.Discussion: Resource expenditure and clinical practice are increasingly guided by subjective patient outcomes, especially in the area of joint replacement. With the current focus on cost-efficiency in healthcare, there is increasing interest in outpatient TJA. By exploring how patients perceive outpatient TJA, this study may serve to guide the development of educational resources and programs to enhance and support outpatient TJA. Addressing concerns identified by patients in an evidence-based manner has the potential to improve patient satisfaction and outcomes in the growing trend of outpatient TJA.