Single-leg versus double-leg hip spica casts in the management of paediatric femoral shaft fractures? A systematic review and meta-analysis.

Background: Paediatric femoral shaft fractures can be managed with single- or double-leg hip spica casting between ages six-months and six-years. The aim of this review was to determine if single-leg hip spicas reduce the impact on family life without compromising fracture stability. Methods: The study was registered on PROSPERO (CRD42023454309). MEDLINE, Embase, Web of Science, Cochrane Library, and clinical trial registers were searched to May 2023 for level I-III evidence. Primary outcomes were impact on family life and fracture stability. Where appropriate, Meta-analysis was completed using RevMan v5.4. Risk of bias was assessed using RoB 2.0 (RCTs) and ROBINS-I (non-RCTs). Certainty of evidence was measured with GRADE. Results: From 234 identified papers, four met the inclusion criteria (two RCTs; two non-RCTs). A total of 339 children were included (single-leg spica: 176; double-leg spica: 163). Three studies were 'high risk' and one study 'moderate risk' of bias. Impact on family life parameters were too heterogenous for pooled meta-analysis. Non-pooled data identified significantly more missed work days in the double-leg spica group and the 'Impact on Family' Scale significantly favoured single-leg spicas. For fracture stability, meta-analysis identified that (i) mal-union rates were significantly lower in single-leg spica: OR 0.08 (95 % CI 0.01 to 0.69; p = 0.02); (ii) MUA in theatre was not significantly different: OR 0.97 (95 % CI 0.19 to 4.86; p = 0.97); and (iii) wedge adjustment was not significantly different: OR 3.46 (95 % CI 0.48 to 24.92; p = 0.22). Certainty of evidence was assessed as 'very low'. Conclusion: Single-leg hip spicas may be associated with reduced impact on family life without compromising fracture stability compared with double-leg hip spicas. However, the evidence is weak. Therefore, a propensity score matched observational study is required to understand if subgroups of patients (age, fracture pattern, mechanism of injury) would benefit from a single- or double-leg hip spica.

UK CoPACK Study: knowledge and confidence of healthcare workers in using personal protective equipment and related anxiety levels during the COVID-19 pandemic.

BACKGROUND: Healthcare workers (HCWs) are at increased risk of coronavirus 2019 (COVID-19) infection. Personal protective equipment (PPE) and infection control guidelines help limit transmission. However, poor confidence leads to higher levels of anxiety rates and infection. We assessed knowledge and confidence in PPE among HCWs and associated anxiety. METHODS: A cross-sectional, multi-centre survey using a validated questionnaire assessing actual and self-perceived knowledge on PPE was distributed among HCWs across the UK. Confidence in PPE and levels of anxiety were assessed using the General Anxiety Disorder-7 (GAD-7) tool. RESULTS: In total, 1,055 responses were received; 99% had familiarity with PPE guidance; however, only 15% correctly answered questions on PPE guidance; 86% and 80% had received mask-fitting and donning-doffing training, respectively; 33% indicated poor/very poor hospital communication. Confidence and anxiety were related to: profession; comorbidities; self-perceived knowledge; and PPE training and communication. CONCLUSION: Confidence in PPE was poor and anxiety was related to inadequate information and training. Thus, improved communication is required for effective response to subsequent COVID-19 waves and similar pandemics.

Osteochondral Lesions of the Ankle Treated with Bone Marrow Concentrate with Hyaluronan and Fibrin: A Single-Centre Study.

Osteochondral defects of the ankle (OCD) are being increasingly identified as a clinically significant consequence of injury to the ankle, with the potential to lead to osteoarthritis if left untreated. The aim of this retrospective cohort study was to evaluate a single-stage treatment of OCD, based on bone marrow aspirate (BMA) centrifuged to produce bone marrow concentrate (BMC). In a dual syringe, the concentrate was mixed with thrombin in one syringe, whereas hyaluronan and fibrinogen were mixed in a second syringe. The two mixtures were then injected and combined into the prepared defect. Clinical outcome and quality of life scores (MOXFQ and EQ-5D) were collected at baseline and yearly thereafter. Multilevel models were used to analyse the pattern of scores over time. Ninety-four patients were treated between 2015 and 2020. The means of each of the three components of the MOXFQ significantly improved between baseline and 1 year (p < 0.001 for each component), with no further change from year 1 to year 3. The EQ-5D index also improved significantly from baseline to 1 year, with no evidence for further change. Our results strongly indicate that this BMC treatment is safe for, and well tolerated by, patients with OCD of the ankle as both primary treatment and those who have failed primary treatment. This technique provides a safe, efficacious alternative to currently employed cartilage repair techniques, with favourable outcomes and a low complication rate at 36 months.

Basosquamous Carcinoma: A Single Centre Clinicopathological Evaluation and Proposal of an Evidence-Based Protocol.

Basosquamous carcinoma (BSC) is an uncommon skin malignancy with significant invasive and metastatic potential. There are currently no clear management guidelines. This study evaluates the management and outcomes of patients diagnosed with BSC over a 7-year period. We present an evidence-based unit protocol for the management of BSC. All patients treated for BSC between 2009 and 2015 were reviewed. Data collected included patient demographics, tumour-specific information, management strategy, presence of recurrence or metastasis, and details of follow-up. 74 patients were identified, making this one of the largest cohorts of BSC patients reported. Mean age at diagnosis was 75.4 years, with a male:female ratio of 1.6:1. The most common tumour site was the head and neck (n=43, 58.1%). All tumours were graded at pT1 (n=51) or pT2 (n=23). Inadequate excision occurred in 17 patients (23%). Mean excision margins were >4mm peripherally and deep. Inadequately excised BSCs were further treated with wide local excision (n=6) or radiotherapy (n=5), or both (n=1). There were no cases of local recurrence or metastatic disease. This study demonstrates a cohort of patients with BSCs that appear less aggressive than previously reported. Current management with surgical excision appears to produce adequate results. However, an evidence-based guideline is still lacking.

Knockdown of zif268 in the Posterior Dorsolateral Striatum Does Not Enduringly Disrupt a Response Memory of a Rewarded T-Maze Task.

Under certain conditions pavlovian memories undergo reconsolidation, whereby the reactivated memory can be disrupted by manipulations such as knockdown of zif268. For instrumental memories, reconsolidation disruption is less well established. Our previous, preliminary data identified that there was an increase in Zif268 in the posterior dorsolateral striatum (pDLS) after expression of an instrumental habit-like 'response' memory, but not an instrumental goal-directed 'place' memory on a T-maze task. Here, the requirement for Zif268 in the reconsolidation of a response memory was tested by knockdown of Zif268, using antisense oligodeoxynucleotide infusion into the pDLS, at memory reactivation. Zif268 knockdown reduced response memory expression 72H, but not 7d later. Western blotting revealed a non-significant increase in Zif268 in the pDLS in rats using response memories, but there was no change in Zif268 expression in the hippocampus following retrieval of a place memory. Zif268 expression increased in the basolateral amygdala after memory reactivation whether a response or place strategy was used during reactivation. We propose that Zif268 expression in the basolateral amygdala may be linked to prediction error, generated by the absence of reward at reactivation. Taken together, these results suggest a complex role for Zif268 in the maintenance of instrumental memories.