Management of complex regional pain syndrome in trauma and orthopaedic surgery-a systematic review.

INTRODUCTION: Complex regional pain syndrome (CRPS) is a neurological pain disorder that is challenging to diagnose and manage, resulting in increased morbidity and costs. It most commonly occurs following traumatic injury, such as a fracture, crush injury or surgery. Recent research has evaluated the efficacy of treatments which have contradicted previous hypotheses. This systematic review summarizes these findings to improve clinician's decision-making. SOURCES OF DATA: A comprehensive search of PubMed, MEDLINE and Embase databases from inception through January 2021 was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two reviewers independently screened relevant articles discussing the management of CRPS in adult trauma patients. All prospective and retrospective studies, non-randomized comparison studies and case series were considered for inclusion. Data extraction was performed by populating a predefined data abstraction sheet. AREAS OF AGREEMENT: There is strong evidence to suggest the efficacy of prompt physiotherapy, lidocaine, ketamine, bisphosphonates, sympathectomy and brachial plexus blocks in the management of CRPS. AREAS OF CONTROVERSY: The latest evidence suggests that vitamin C has no significant role to play in the treatment or prevention of CRPS. GROWING POINTS: A multidisciplinary team approach and early diagnosis are imperative for successful treatment of CRPS. The Budapest criteria and the British Orthopaedic Association Standards for Trauma and Orthopaedics (BOAST) guidelines should be used when diagnosing CRPS. There is currently no clear evidence of superiority in any treatment. AREAS TIMELY FOR DEVELOPING RESEARCH: There are few high-quality studies that inform the best treatment modalities for CRPS. Though emerging treatments show promise, further research is needed.

A Systematic Review of the Medical Student Feedback on Undergraduate Surgical Education During the Pandemic.

The coronavirus disease 2019 (COVID-19) pandemic has challenged and changed significant aspects of day-to-day life. With regard to medical education, the challenges have been substantial, and the changes have been innovative. This systematic review focuses specifically on medical student feedback on undergraduate surgical education during the pandemic. It explores the various types of technology used to facilitate online learning and aims to comprehensively review the advantages and disadvantages. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were adhered to, and electronic databases PubMed, Medline, and Scopus were used to identify relevant studies. The search yielded 102 papers once duplicates and non-English articles were removed. Of these, 19 articles were included in the review. These publications were appraised, which was the source of the narrative syntheses of this systematic review, and due to the heterogeneous data, a meta-analysis could not be successfully implemented. The integration of real-time image capture devices used to display stakeholders or objects such as models of wounds has resulted in the improvement of virtual learning to an almost in-person experience. Adding to this, the use of communication and participation platforms facilitates active discussion when used appropriately. However, there are still some barriers that may be removed with time as the technology continually improves, and these are not exclusive to connectivity issues and restriction of the senses to only two-dimensional sight and hearing. Despite this, the student feedback was largely positive, and the integration of more innovative methods of delivering teaching will have a positive impact on education as long as it is used as an adjunct and not as a replacement for face-to-face teaching.

A Three-Step System to Ensure Correct Attribution of Named Clinicians for Inpatients.

BACKGROUND: The Francis report recommends that all patients admitted into a UK hospital must have a named identifiable and suitably trained consultant or clinician in charge of their care. This is regarded as a shared responsibility as highlighted by the recommendations made by the General Medical Council Best Practice guidance. However, this can become more error-prone, particularly in acute trauma and orthopaedic inpatients when the named consultant may change numerous times. METHODS: We conducted an audit reviewing all the inpatients in the acute trauma and orthopaedic wards and then reaudited twice following the introduction of the three-step system. The results were then analysed and compared with previous cycle results. RESULTS: Initially following the introduction of the three-step system, there were poorer outcomes. Inpatients with the correct named consultant declined from 47% to 37%. However, following further education and training of each respective member of the multidisciplinary roles, the results were much improved with 88.9% of the inpatients having the correct named consultant. CONCLUSIONS: Ensuring that all inpatients have the correct named consultant is a shared responsibility amongst all health and social care staff involved with the patient. This audit highlights that attributing specific roles to relevant members of the multidisciplinary team can improve communications and patient care.

Treatment modalities for hip and knee osteoarthritis: A systematic review of safety.

Current guidelines on the management of hip and knee osteoarthritis (OA) do not compare safety of treatment modalities. We therefore systematically reviewed 20 studies investigating mortality and serious complications of both medical and surgical treatments for hip and knee OA using PubMed, Scopus, Web of Knowledge and Google Scholar. Mortality was the highest for naproxen (hazard ratio (HR) = 3 (1.9, 4.6)) and lowest for total hip replacement (relative risk (RR) = 0.7 (0.7, 0.7)). Highest gastrointestinal complications were reported for diclofenac (odds ratio (OR) = 4.77 (3.94, 5.76)) and lowest for total knee replacement (HR = 0.6 (0.49, 0.75)). Ibuprofen had the highest renal complications (OR = 2.32 (1.45, 3.71)), whereas celecoxib had the highest cardiovascular risk (OR = 2.26 (1, 5.1)) and lowest was for tramadol (RR = 1.1 (0.87, 1.4)). Results show that medical management of hip and knee OA, particularly with non-steroidal anti-inflammatory drugs, may carry higher mortality compared to surgery. Careful consideration should be given to medical management taking into account known co-morbidities.