Prof. Kevork Hopayian has recently published the following article:

Kevork Hopayian, James Heathcote. Deep gluteal syndrome: an overlooked cause of sciatica. [editorial]. Br J Gen Pract 2019;69(687):485.

Abstract:

Mention sciatica and most clinicians will first think of pressure on the lumbosacral nerve roots from a herniated intervertebral disc or stenosis of the spinal canal. Magnetic resonance imaging (MRI) raised hopes of making more precise anatomical diagnoses, but MRI, as routinely practised, fails to demonstrate the cause in as many as 49% of patients1 while disc lesions are present in many asymptomatic people.

A less well known cause of sciatica is impingement of the nerve trunk from a range of musculoskeletal conditions that compress the sciatic nerve as it passes through the confines of the deep gluteal space, termed the deep gluteal syndrome (DGS). This editorial seeks to answer four questions. First, what is the evidence that deep gluteal syndrome exists? Second, how common is it? Third, are there accurate diagnostic tests?

As a diagnostic term, DGS includes several pathologies which cannot be distinguished clinically. Its value lies in shifting the focus away from radiculopathy with two important consequences. First, it opens up treatment in the form of an alternative approach to physiotherapy and DGS-specific surgical options. Second, regardless of treatment, it answers patients’ need for an explanation. Patients who do not receive an explanation for chronic back pain or sciatica suffer not only the direct consequences of their condition, but also the despair arising from the lack of a legitimising diagnosis

 

Prof. Kevork Hopayian has also participated  in two conferences:
  • Kevork Hopayian. SAFOBAD A generic, internal validity assessment tool for light touch evidence based practice. Poster, 9th International Conference Evidence-Based Health Care Teachers and Developers, Taormina, Sicily 6-9 November 2019.

Abstract

Background: Appraising internal validity requires knowledge and skills that most practitioners are not interested in or fearful of studying. It was argued at the 2003 EBHC conference that a stratified approach to teaching is needed. For most practitioners, the aim should be to offer basic knowledge and skills (light touch EBP). Appraisal of internal validity requires knowledge of study designs and biases, some of which are specific to each study design. Existing appraisal tools are mostly study specific meaning that a practitioner must acquire a multitude of checklists for use. A simple, generic, appraisal tool could play a part in teaching light touch EBP.  Methods: Building upon Sackett’s division of biases into the phases of a study and Delgado-Rodríguez and Llorca’s classification, biases were grouped into three phases. To the usual before and during data collection classification, an after phase was added to include analysis. Each phase was subdivided into facets of research to create a mnemonic. The tool was tested by mapping against study designs and the classification of biases. Results: A tool was developed that relates to all quantitative study designs and translates into a mnemonic relevant to the appraisal process: Scrutinise All Facets (of a study) Otherwise Bias Avoids Detection = SAFOBAD = Selection Allocation Follow-up Outcomes Blinding Analysis Discussion. SAFOBAD has been used for critical appraisal exercises both in classroom teaching and written assignments in the international, online, post-graduate training programme of family medicine at the University of Nicosia Medical School, Cyprus.

Conclusions:  SAFOBAD encompasses basic principles and all research designs, is simple to learn, remember and use, and can be used as a framework in lessons across study types. It could play a part in the education and implementation of the light touch EBP appropriate for the majority of practitioners.

 

  • Kevork Hopayian. Synthesis of evidence from case studies – Shining a light or Blocking the view? Plenary Presentation, 9th International Conference Evidence-Based Health Care Teachers and Developers, Taormina, Sicily 6-9 November 2019.

 Abstract:

The fallibility of generalizing from cases and the attendant problems of bias mean case studies are mostly ignored by evidence based practice developers.  While case reports and series may be the ‘lowest/weakest’ form of evidence they are often the first and sometimes the only line of evidence. Successful systematic reviews of rare conditions have been conducted in the areas of diagnosis, harm (drug and post-op), prevalence and treatment. Synthesis of case studies presents specific problems. Notes made for clinical practice are often not adequate for research. The rapid growth of case report journals has increased quantity without necessarily quality. However, reporting guidelines for case studies now exist. Treated with the same scientific rigor, case studies have the potential to inform both practice, while other forms of evidence are collected, and research, pointing to fruitful questions.