Prospective observational cohort study.To evaluate the comparative responsiveness of Oswestry Disability Index (ODI, version 2.0), 24-item Roland-Morris Disability Questionnaire (RMDQ), 12-item Short-Form Health Survey (SF-12) physical component score (PCS), and SF-12 mental component score (MCS) in patients that underwent micro-discectomy for lumbar disc herniation.Responsiveness is a context specific term and no study has reported the responsiveness of ODI version 2.0, RMDQ, SF-12 PCS, or SF-12 MCS in discectomy patients.Responsiveness was assessed using distribution-based methods (effect size [ES], standardized response means [SRM ], SRM difference between patients who improved and those who did not show improvement [SRM difference]), and the anchor-based method (area under the curve [AUC] of receiver operating characteristic curves). Values of ES and SRM higher than 0.8, and AUC value higher than 0.7 suggest adequate responsiveness. Outcome instrument demonstrating the highest value of SRM difference and AUC was considered the most responsive.Responsiveness was assessed in 98 participants at a mean follow-up time of 12 weeks postoperatively. The overall ES of RMDQ, ODI, SF-12 PCS, and SF-12 MCS was 2.15, 2.11, 2.08, and 0.86, respectively. The overall SRM of ODI, RMDQ, SF-12 PCS, and SF-12 MCS was 1.36, 1.43, 1.24, and 0.65, respectively. The SRM difference in RMDQ, ODI, SF-12 PCS, and SF-12 MCS was 2.64, 2.26, 1.32, and 1.29, respectively. The AUC of ODI, RMDQ, SF-12 PCS, and SF-12 MCS was 0.96, 0.96, 0.83, and 0.83, respectively.ODI, RMDQ, SF-12 PCS, and SF-12 MCS demonstrated adequate responsiveness in a homogenous cohort of patients who underwent lumbar micro-discectomy. ODI and RMDQ are equally responsive and, thus, are interchangeable instruments for region specific outcomes. Both the SF-12 PCS and SF-12 MCS can assess the quality of life following lumbar micro-discectomy.
Steroid injection of the hip joint is a common procedure. Radiological confirmation of correct needle placement is believed to be necessary for a successful injection when commonly described approaches are used (1,2). We describe a less commonly used approach for hip injection, which makes it possible to give intra-articular injections without the need for radiological confirmation. We have used this method to inject 100 hips over the past four years with a 90% accuracy rate. This method is easy to learn, reliable, and could potentially be used in the outpatient setting, thus avoiding delays on the waiting lists.
Clear guidelines are set by the British Orthopaedic Association (BOA) and British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS) on the preoperative management of open fractures. This as well as the clinical consequences of poor management of open fractures means the patient workup for surgery is important as well as the timing of surgery. Experience suggests few patients are managed 100% as per the guidelines and we look to test this hypothesis. A retrospective analysis was undertaken of all open long bone fractures (total 133), excluding hand injuries, which presented to a district general hospital over a 5-year period. The implementation of 7 defined key tasks for initial management was recorded. 101 cases were eligible, with the majority of cases (71.4%) having initial orthopaedic assessment outside normal working hours. The mean number of tasks completed was 3.23/7. Assessment out of hours was associated with less tasks being implemented but doctor seniority and the presence of polytrauma made no difference to the quality of acute care. Staff involved in the acute care of open fractures require targeted education to improve the delivery of initial preoperative care. We recommend that other centres assess their performance against this data.
Introduction With 1.9 million neurons lost every minute a stroke is untreated, rapid assessment and treatment is a time critical medical emergency. Rapid access to CT imaging is an immediate priority to allow exclusion of patients with haemorrhagic strokes and absolute contraindications to thrombolysis therapy. Our QI project aimed to reduce time from arrival to CT for patients presenting with potentially thrombolysable stroke. With simulation becoming increasingly prevalent within medical education our aim was to incorporate simulation as a key process in delivering quantifiable change in practice. Methods We initially used in situ simulation to live process map the care of a potentially thrombolysable patient through the ED at FVRH. By running a number of simulated scenarios we identified ‘unnecessary’ delays from non-value adding activity and created a new streamlined protocol for this patient group which facilitated rapid assessment, stabilisation and access to CT imaging. This protocol was rolled out in liaison with the on-site stroke team and PDSA cycles were initiated to enable rapid cycle change. We then used regular in-situ simulation training to train and subsequently continually stress the system. Results Through the use of our updated patient flow pathways in conjunction with in situ simulation training and education the department door to CT time was reduced by 40%, from 30 minutes (median 23) to 18 minutes (median 13). Conclusion Use of simulation for process mapping and production of a streamlined protocol for patients presenting with hyper-acute stroke and regular simulation training allows for a net reduction in ‘Time-to-CT’. This improves patient safety by enabling greater time for appropriately trained and designated staff to decide on treatment and administer thrombolysis therapy more rapidly. It will enable the department to meet the current SCCAG targets of delivering thrombolysis within 30 minutes.
Reports of chemical burns beneath tourniquets during orthopaedic procedures led us to explore the irritant effects produced by the skin antiseptics used during such procedures. A sphygmomanometer and tourniquet, at a pressure of 200 mmHg for 30 min, was used to created pressure and ischaemia which were then examined separately for their respective effects on irritant inflammation in normal subjects and those with atopic eczema. As no inflammation could be demonstrated with the antiseptics, we subsequently used the known irritant chemical anthralin to examine the effect of ischaemia with and without pressure. Site-related variation in anthralin-induced inflammation was observed but there was no demonstrable effect of either pressure or ischaemia on the inflammatory response. Therefore, as we are unable to show a relationship between ischaemia with or without pressure and irritant inflammation, we conclude that burns under tourniquets are likely to be idiosyncratic reactions and their further investigation requires examination of the individuals affected.
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