Minimally invasive reduction and percutaneous fixation versus open reduction and internal fixation for displaced intra-articular calcaneal fractures: A systematic review of the literature.

The aim of this article is to systematically identify and analyse research evidence available to compare the outcomes of minimally invasive reduction and percutaneous fixation (MIRPF) versus open reduction and internal fixation (ORIF) for displaced intra-articular calcaneal fractures.Articles from 2000 to 2016 were searched through MEDLINE (PubMed), Cochrane Library, Embase, ScienceDirect, Scopus and ISI Web of Knowledge using Boolean logic and text words. Of the 570 articles identified initially, nine were selected including three randomized controlled trials and six retrospective comparative studies.All nine studies had a total of 1031 patients with 1102 displaced intra-articular calcaneal fractures. Mean follow-up was 33 months. Of these, 602 (54.6%) were treated with MIRPF and 500 (45.4%) were treated with ORIF.Overall incidence of wound-related complications in patients treated with MIRPF was 4.3% (0% to 13%) compared with 21.2% (11.7% to 35%) in the ORIF groupFunctional outcomes were reported to be better in the minimally invasive group in all studies; however, the results did not reach statistical significance in some studies. All the studies had methodological flaws that put them at either 'unclear' or 'high' risk of bias for multiple domains.Overall quality of the available evidence is poor in support of either surgical technique due to small sample size, flaws in study designs and high risk of bias for various elements. Individual studies have reported minimally invasive techniques to be an effective alternative with lower risk of wound complications and better functional outcomes. Cite this article: EFORT Open Rev 2018;3:418-425. DOI: 10.1302/2058-5241.3.170043.

The effect of corticosteroid versus platelet-rich plasma injection therapies for the management of lateral epicondylitis: A systematic review.

INTRODUCTION: Lateral epicondylitis is a common musculoskeletal disorder of the upper limb. Corticosteroid injection has been widely used as a major mode of treatment. However, better understanding of the pathophysiology of the disease led to a major change in treating the disease, with new options including platelet-rich plasma (PRP) are currently used. Objectives/research aim: To systematically evaluate the effect of corticosteroid versus PRP injections for the treatment of LE. HYPOTHESIS: PRP injections provide longer-term therapeutic effect and less rate of complications compared to corticosteroid injection. LEVEL OF EVIDENCE: Level 2 evidence (4 included studies are of level 1 evidence, 1 study of level 2 evidence). DESIGN: Systematic Review (according to PRISMA guidelines). METHODS: Eleven databases used to search for relevant primary studies comparing the effects of corticosteroid and PRP injections for the treatment of LE. Quality appraisal of studies performed using Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0, CASP Randomised Controlled Trial Checklist, and SIGN Methodology Checklist 2. RESULTS: 732 papers were identified. Five randomised controlled trials (250 Patients) met the inclusion criteria. CLINICAL FINDINGS: Corticosteroid injections provided rapid symptomatic improvement with maximum effect at 6/8/8 weeks before symptoms recurrence, whereas PRP showed slower ongoing improvements up to 24/52/104 weeks(3 studies). Corticosteroid showed more rapid symptomatic improvement of symptoms compared to PRP up to the study end-point of 3 months(1 study). Comparable therapeutic effects of corticosteroid and PRP were observed at 6 weeks(1 study). Ultrasonographic Findings: (1) Doppler activity decreased more significantly in patients who received corticosteroid compared to PRP. (2) Reduced tendon thickness and more patients with cortical erosion noted in corticosteroid group whereas increased tendon thickness and less number of patients with common extensor tendon tears noted in PRP group. (3) Fewer patients reported Probe-induced tenderness and oedema in the common extensor tendon in both corticosteroid and PRP groups (2 studies). CONCLUSION: Corticosteroid injections provide rapid therapeutic effect in the short-term with recurrence of symptoms afterwards, compared to the relatively slower but longer-term effect of platelet-rich plasma.

Which alternative communication methods are effective for voiceless patients in Intensive Care Units? A systematic review.

OBJECTIVE: To assess the effectiveness of Augmentative and Alternative Communication (AAC) strategies to enable people who are temporarily voiceless due to medical intervention, to communicate. METHODS: A systematic review informed by a protocol published on an international register. Ten databases were searched from January 2004 to January 2017. Included studies assessed the effect of using AAC strategies on patient related outcomes and barriers to their use. All included studies were quality appraised. Due to the heterogeneity of interventions and outcome measures findings were narratively reviewed. RESULTS: Twelve studies met the inclusion criteria and were included in the review reporting outcomes from 1981 patient and 454 health professional participants. The quality of included studies were moderate to weak. AAC communication strategies increased the number of communication interactions, improved patient satisfaction with communication and reduced communication difficulties. Barriers to usage were device characteristics, the clinical condition of the patient, lack of timeliness in communication and staff constraints. CONCLUSIONS: There is preliminary, but inconsistent evidence that AAC strategies are effective in improving patient satisfaction with communication and reducing difficulties in communication. A lack of comparable studies precluded the identification of the most effective AAC strategy.

Improving the quality of handover by addressing handover culture and introducing a new, multi-disciplinary, team-based handover meeting.

Handover is a "major preventable cause of patient harm"[1] and this project aims to improve the quality of night handover within a teaching hospitals general medicine department, resulting in the safe transfer of patient care to the night team. Quality of handover was assessed both qualitatively, via structured qualitative interviews with trainees and a baseline survey assessing doctor's opinions of night handover, and quantitatively through the collection of a data set during regular observation of night handover. The initial intervention instituted a new handover meeting with a set time and new location and invited the night nurse practitioner to attend. A prompt card, standardised documentation, defined leadership, and an attendance register were also introduced. Successive PDSA cycles introduced technology to the intervention, enabled the nurse night practitioners to actually attend and re-branded the prompt card as an agenda. Results show a sustained reduction in length of handover from 70 minutes (n=7) to 34 minutes (n=13) post-intervention as well as a reduction in the number of distractions occurring during each handover from a mean of 14 to a mean of 8.5. An improved quality of handover was also demonstrated with an overall increase in the percentage of task handovers containing hospital number, an admitting diagnosis, comorbidities and a time allocated for the task to be performed of at least 10%. When trainees were surveyed post-implementation they unanimously identified the new handover system as safer than the previous handover process (n=30). This project demonstrates that replacing an ad-hoc system of handover with a multi-disciplinary, team based approach to handover improves handover quality. In addition it provides a useful guide to introducing a new handover meeting to a department and contains useful lessons on how to combat cultural barriers to change within a department.

Literacy and numeracy for pre-registration nursing programmes: 1. An innovative way to widen access to nursing programmes for students without formal qualifications by enabling them to give evidence of their literacy and numeracy skills.

The Nursing and Midwifery Council (NMC, 2003) removed standard entry criteria for nursing programmes and asked Higher Education Institutions (HEIs) to consider the literacy and numeracy skills of prospective students. This triggered admissions staff within a Faculty of Health to consider ways of attracting people with the right skills but not the qualifications to prove it. It is important to encourage a wide range of people into nursing to meet the demands of strategic plans and policy, as well as to ensure the nursing profession reflects the diverse client groups it serves. Removing standard entry criteria and the widening participation agenda gave an ideal opportunity to try something new. A course entitled 'Portfolio of Evidence for Entry to Level 1 Study' was developed within the Faculty of Health at Staffordshire University to enable potential nursing students without standard entry qualifications to demonstrate their skills in numeracy and literacy. This paper reports on the background to this course and its success for three student cohorts (over an 18 month period) who have completed their first year of pre-registration nursing. The methodology employed is descriptive, qualitative analysis, comparing portfolio and standard entry students' assignment results.

The validity and accuracy of clinical tests used to detect labral pathology of the shoulder--a systematic review.

Labral tears frequently require repair [Kim S, Ha K, Han K. Biceps Load test: a clinical test for superior labrum anterior and posterior lesions in shoulders with recurrent anterior dislocations. The American Journal of Sports Medicine 1999;27(3):300-3]. Physiotherapists need confidence in clinical tests used to detect labral pathology to accurately identify this condition. This review systematically evaluates the evidence for the accuracy of these tests with reference to study quality and key biases. Cochrane, Medline, Cinahl, AMED, DARE and HTA databases were searched to identify 15 studies evaluating 15 clinical tests for labral pathology against Magnetic Resonance Imaging MRI or surgery. Two independent reviewers assessed methodological quality using Quality Assessment of Diagnostic Accuracy Studies (QUADAS). Meta Disc calculated likelihood ratios (positive LR>10, providing convincing diagnostic evidence of ruling a condition in; negative LR<0.2 providing large to moderate evidence of ruling the condition out) and true positive rates (TPRs) against false positive rates (FPRs) in receiver operator characteristic (ROC) plots and summary receiver operator curves (SROCs). Probable overestimation of accuracy was caused by use of case control design, verification bias and use of a lesser reference standard. Six accurate tests; Biceps Load I (+LR: 29.09; -LR: 0.09) Biceps Load II (+LR: 26.32; -LR: 0.11), Internal Rotation Resistance (IRRT) (+LR: 24.77; -LR: 0.12), Crank (+LR: 13.59 and 6.46; -LR: 0.1 and 0.22), Kim (+LR: 12.62; -LR:0.21) and Jerk (+LR: 34.71; -LR: 0.27) tests were identified from high quality single studies in selected populations. Subgroup analysis identified varying results of accuracy in the Crank test and the Active Compression (AC) test when evaluated in more than one study. Further evaluation is needed before these tests can be used with confidence.