Comparison of Digital Versus Conventional Documentation of Ward Round in Terms of Staff Satisfaction, Effect on Education, and Adherence to British Orthopaedic Association Guidelines.

Objective To compare the role of paper-based versus digital record keeping in the orthopaedic ward in terms of staff satisfaction, education of staff, and adherence to British Orthopaedic Association (BOA) guidelines. Materials and methods Forty-four participants including nurses, senior house officers, foundation year trainees, and consultants completed a questionnaire. The first survey was done to introduce electronic records keeping to the participants and the second survey was conducted to review the collected record. Three parameters were assessed, which were adherence to BOA guidelines, staff satisfaction, and effect of education for both paper-based and electronic records. Comparison between two methods of record keeping was done by independent t-test for continuous data and chi-square test for categorical.  Results For all four questions about staff satisfaction, the score of the electronic method was higher than paperwork statistically. The score for 'opportunity to learn images in ward round' was higher in electronic (3.9±0.8) than paperwork (2.6±1.3) statistically (p<0.001). Comparable results were found for 'educational usefulness of ward round' and 'typing time affecting learning time'. For adherence to guidelines, the electronic record keeping was more effective in storing the patient's ID and name (p=0.05), details of documenting clinician (p<0.001), time of ward round ((p=0.005), whom to contact in case of concern (p=0.050), and grade of ward round clinician (<0.001). Conclusion Electronic records in the orthopaedic ward were deemed better than paperwork in terms of staff satisfaction, positive effect on the education of doctors, and adherence to BOA guidelines.

Effective adsorption of perrhenate ions on the filamentous sheath-forming bacteria, Sphaerotilus montanus, Sphaerotilus natans and Thiothrix fructosivorans.

AIMS: This study aimed to unveil perrhenate sorption properties of the filamentous sheaths formed by Sphaerotilus montanus, Sphaerotilus natans and Thiothrix fructosivorans. METHODS AND RESULTS: The adsorptions of perrhenate on lyophilizates of the above-mentioned filamentous sheaths were analysed by ICP, IR, XPS and EDX. The capacity reached 82 mg per g-adsorbent, when using S. natans. The Langmuir coefficient of this adsorbent was found to be the largest of the three. The adsorption capacity was discussed with respect to the amount of nitrogen and phosphorus in the adsorbents. The occurrence of anion exchange was implied by the IR spectrum changes before and after adsorption. The adsorption data fitted well with a pseudo-second-order equation, suggesting that the rate is determined by the chemical bond formation. CONCLUSIONS: A significant amount of perrhenate was adsorbed on the sheaths formed by S. montanus, S. natans and T. fructosivorans. The adsorption was correlated with the elemental compositions. A strong chemical bond formation was suggested from the results of the Langmuir adsorption isotherm and kinetic analysis. SIGNIFICANCE AND IMPACT OF STUDY: The capacity obtained for S. natans is one of the largest adsorptions amongst the similar biomaterials, implying the possibility of providing economical adsorbents of rare metal oxyanions.

Hip and distal femur fracture outcomes over three successive UK lockdown periods during the COVID-19 pandemic: what have we learnt? : a single-centre retrospective cohort study.

AIMS: This study assessed the impact of COVID-19 on hip and distal femur fracture patient outcomes across three successive UK lockdown periods over one year. METHODS: A single-centre retrospective cohort study was performed at an acute NHS Trust. Hip and distal femur fracture patients admitted within the first month from each of the three starting dates of each national lockdown were included and compared to a control group in March 2019. Data were collected as per the best practice tariff outcomes including additional outcomes as required. Data collection included COVID-19 status, time to theatre, 30-day mortality, presence of acute kidney injury (AKI) and pneumonia, and do not attempt cardiopulmonary resuscitation (DNACPR) status. Data were analyzed using an independent-samples t-test or chi-squared test with Fisher's exact test where applicable. A p-value of < 0.05 was considered statistically significant. RESULTS: A total of 95 patients during the pandemic were included and 20 were COVID-positive. Patients experienced a statistically significant increase in time to theatre in Lockdown 1 compared to 2019 (p = 0.039) with a decrease with successive lockdown periods by Lockdown 3. The 30-day mortality increased from 8.8% in 2019 to 10.0% to 14.8% in all lockdown periods. COVID-positive patient mortality was 30.0% (p = 0.063, odds ratio (OR) = 4.43 vs 2019). The rates of AKI and pneumonia experienced were higher for patients during the pandemic. The highest rates were experienced in COVID-positive patients, with 45.0% of patients with AKI versus 27.0% in 2019 (p = 0.38, OR = 1.80), and 50.0% of patients diagnosed with pneumonia versus 16.2% in 2019 (p = 0.0012, OR = 5.17). The percentage of patients with a DNACPR increased from 30.0% in 2019 to 60.7% by Lockdown 3 (p = 0.034, OR = 3.61). CONCLUSION: COVID-positive hip and distal femur fracture patients are at a higher risk of mortality due to AKI and pneumonia. Patient outcomes have improved with successive lockdowns to pre-pandemic levels. Cite this article: Bone Jt Open 2021;2(12):1017-1026.

Carbon fibre reinforced PEEK versus traditional metallic implants for orthopaedic trauma surgery: A systematic review.

INTRODUCTION: There is no literature review comparing outcomes of fixation using carbon-fibre-reinforced polyetheretherketone (CFR PEEK) compared to metal implants used in orthopaedic extremity trauma surgery. A systematic review was performed to compare CFR PEEK to metal implants for clinically-important fracture outcomes. METHODS: A search of the online databases of PubMed/Medline, EMBASE and Cochrane Database was conducted. A systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A meta-analyses was performed for functional outcomes in proximal humerus fractures converting the score differences to standard mean difference units. GRADE approach was used to determine the level of certainty of the estimates. RESULTS: Two prospective randomised controlled trials and seven comparative observational studies with a total of 431 patients were included. Of the nine studies included, four compared the use of CFR PEEK against metal plates in proximal humerus fractures. Aggregated functional scores across the proximal humerus studies, there was a small signal of better improvement with CFR PEEK (SMD 0.22, 95% CI -0.03 to 0.47, p = 0.08, low certainty). Greater odds of adverse events occurred in the metal group (OR 2.34, 95% CI 0.73 to 7.55, p = 0.15, low certainty). CONCLUSIONS: Low to very low certainty evidence suggests a small improvement in functional recovery with CFR PEEK in proximal humerus fractures. This may be mediated through a small reduction in major adverse events related to fracture healing and stability. There is currently insufficient evidence to support the widespread use of CFR PEEK implants in fracture fixation. LEVEL OF EVIDENCE: Level IV.

Orthopaedic Trauma Theatre Efficiency in the COVID-19 Pandemic: Are We Returning to Normality?

Background Recent studies have shown a decline in theatre efficiency and productivity coinciding with the coronavirus disease 2019 (COVID-19) pandemic. In this study, we evaluate trauma theatre task efficiency in three different time periods (April 2019, April 2020, and November 2020), and analyse if productivity has altered since the start of the pandemic. Methods The records of a total of 320 patients who underwent orthopaedic trauma surgery at a large district general hospital in April 2019, April 2020 (during the first wave of the pandemic) and November 2020 (during the second wave of the pandemic) were analysed. Primary outcomes measured include time to get to the theatre, anaesthetic preparation time, the sum of time of anaesthesia and surgical preparation time, duration of surgery and time to transfer to recovery. Patient demographics as well as the type of surgery were also analysed. Results The time to get to the theatre and anaesthetic preparation time significantly increased in April 2020 (p<0.05) but fell in November 2020 with no significant difference in comparison to before the pandemic in April 2019 (p>0.05). The duration of surgery and time to transfer to recovery significantly increased in April 2020 (p<0.05) and though reduced in November 2020, was still significantly greater in comparison to April 2019 (p<0.05). In April 2020, the proportion of patients aged 18-65 was just 26% as compared to 35% in April 2019. This figure rose again to 45% in November 2020. The number of hip fracture procedures remained similar during the three time periods, with 32, 32 and 36 hip fracture operations in April 2019, April 2020 and November 2020, respectively. Conclusion While operating theatres' efficiency decreased during the first wave of the COVID-19 pandemic, it increased again in the second wave, coming close to the 'normal' levels before the pandemic struck.

Assessment of caregiver burden of patients receiving dialysis treatment in Rawalpindi.

OBJECTIVE: To determine the burden on the caregivers of patients receiving dialysis treatment. METHODS: This cross-sectional study was carried out in four different dialysis centres of Rawalpindi, Pakistan, from June 1 to December1, 2015, and comprised attendants of patients receiving dialysis. The data was collected from the attendants of patients receiving dialysis, and caregiver burden was measured using the Zarit Burden Interview questionnaire. SPSS 22 was used for data analysis. RESULTS: Of the 164 subjects, 97(59%) were females. The majority of caregivers reported stress for caring (2.28±1.31), patients asking for more help than needed (2.14±1.13), health problems (1.03±1.11), financial constraints (1.70±1.15) and little time for self-care (2.15±1.21). Besides, 107(65%) caregivers perceived the burden of their patients as mild to moderate. A positive correlation was found between the duration of a person on dialysis, daily hours of care-giving and the total burden score of his/her caregiver (p<0.05 each). CONCLUSIONS: Care-giving can create enormous burdens on caregivers, affecting their physical and psychological health.

Music Genre as a Predictor of Resource Utilization at Outdoor Music Concerts.

OBJECTIVES: The aim of this study was to examine the various modern music genres and their effect on the utilization of medical resources with analysis and adjustment for potential confounders. METHODS: A retrospective review of patient logs from an open-air, contemporary amphitheater over a period of 10 years was performed. Variables recorded by the medical personnel for each concert included the attendance, description of the weather, and a patient log in which nature and outcome were recorded. The primary outcomes were associations of genres with the medical usage rate (MUR). Secondary outcomes investigated were the association of confounders and the influences on the level of care provided, the transport rate, and the nature of medical complaint. RESULTS: A total of 2,399,864 concert attendees, of which 4,546 patients presented to venue Emergency Medical Services (EMS) during 403 concerts with an average of 11.4 patients (annual range 7.1-17.4) each concert. Of potential confounders, only the heat index ≥90°F (32.2°C) and whether the event was a festival were significant (P=.027 and .001, respectively). After adjustment, the genres with significantly increased MUR in decreasing order were: alternative rock, hip-hop/rap, modern rock, heavy metal/hard rock, and country music (P<.05). Medical complaints were significantly increased with alternative rock or when the heat index was ≥90°F (32.2°C; P<.001). Traumatic injuries were most significantly increased with alternative rock (P<.001). Alcohol or drug intoxication was significantly more common in hip-hop/rap (P<.001). Transport rates were highest with alcohol/drug intoxicated patients (P<.001), lowest with traumatic injuries (P=.004), and negatively affected by heat index ≥90°F (32.2°C; P=.008), alternative rock (P=.017), and country music (P=.033). CONCLUSION: Alternative rock, hip-hop/rap, modern rock, heavy metal/hard rock, and country music concerts had higher levels of medical resource utilization. High heat indices and music festivals also increase the MUR. This information can assist event planners with preparation and resource utilization. Future research should focus on prospective validation of the regression equation. Westrol MS , Koneru S , McIntyre N , Caruso AT , Arshad FH , Merlin MA . Music genre as a predictor of resource utilization at outdoor music concerts. Prehosp Disaster Med. 2017;32(3):289-296.

Communication aid requirements of intensive care unit patients with transient speech loss.

Alert and transiently nonvocal intensive care unit (ICU) patients are dependent on augmentative and alternative communication (AAC). Unfortunately, the literature demonstrates that existent AAC devices have not been widely adopted, and unaided methods are often the primary modalities used despite being insufficient, and frustrating. We present the results of a qualitative semi-structured interview study with 8 ex-ICU patients, 4 ICU patient relatives, and 6 ICU staff, exploring their AAC needs and requirements. Participants identified important AAC hardware, software, and content requirements. Salient factors impacting on AAC adoption in the ICU setting were also highlighted and included the need for staff training and bedside patient assessment. Based on the study results, we propose a series of recommendations regarding the design and implementation of future AAC tools specifically targeted at this group.

A Case Series of Double Sequence Defibrillation.

INTRODUCTION: Double Sequence Defibrillation or Double Simultaneous Defibrillation (DSD) is the use of two defibrillators almost simultaneously at their highest allowed energy setting to treat refractory ventricular fibrillation (RVF). One set of pads is placed in the Anterior-Posterior position and the other set of pads is placed in the Anterior-Lateral Position. Both defibrillation buttons are pressed simultaneously. We sought to determine ROSC and survival rates in a large EMS system when DSD is routinely utilized for RVF. METHOD: A retrospective case series was performed of all patients who received DSD from January 1, 2015 to April 30, 2015. During the four month period, we requested physicians to instruct paramedics to use DSD on patients after three refractory episodes of VF. All Advanced Cardiac Life Support (ALS) patients treated by paramedics are discussed via telephone communication with a physician in the system of 100 ALS treated patients per day. RESULTS: From January 1, 2015 to April 1, 2015, a total of 7 patients were treated with DSD. The mean age was 62 (Range: 45-78), with mean resuscitation time of 34.3 minutes before first DSD (Range: 23-48). The mean number of single shocks was 5.4 prior to DSD (Range: 3-9), with a mean of 2 DSD shocks delivered. VF converted after DSD in 5 cases (57.1%). Four patients survived to admission (43%). Three patients survived to discharge with no or minimal neurologic disability (28.6%). The mean Cerebral Performance Category Scale was 3.4 with 1 indicating good cerebral performance and 5 indicating Brain Death. DISCUSSION: The correct amount of energy in joules for VF remains unknown. In this case series, significant patients converted out of VF. The reason for improved VF conversion may be several factors including additional defibrillation vectors, increased energy, more energy across myocardium, and unknown variables. Additional research is underway to determine if routine DSD will result in improved survival compared to standard defibrillation techniques.

A modified simple triage and rapid treatment algorithm from the New York City (USA) Fire Department.

INTRODUCTION: The objective of this study was to determine if modification of the Simple Triage and Rapid Treatment (START) system by the addition of an Orange category, intermediate between the most critically injured (Red) and the non-critical, non-ambulatory injured (Yellow), would reduce over- and under-triage rates in a simulated mass-casualty incident (MCI) exercise. METHODS: A computer-simulation exercise of identical presentations of an MCI scenario involving a 2-train collision, with 28 case scenarios, was provided for triaging to two groups: the Fire Department of the City of New York (FDNY; n=1,347) using modified START, and the Emergency Medical Services (EMS) providers from the Eagles 2012 EMS conference (Lafayette, Louisiana USA; n=110) using unmodified START. Percent correct by triage category was calculated for each group. Performance was then compared between the two EMS groups on the five cases where Orange was the correct answer under the modified START system. RESULTS: Overall, FDNY-EMS providers correctly triaged 91.2% of cases using FDNY-START whereas non-FDNY-Eagles providers correctly triaged 87.1% of cases using unmodified START. In analysis of the five Orange cases (chest pain or dyspnea without obvious trauma), FDNY-EMS performed significantly better using FDNY-START, correctly triaging 86.3% of cases (over-triage 1.5%; under-triage 12.2%), whereas the non-FDNY-Eagles group using unmodified START correctly triaged 81.5% of cases (over-triage 17.3%; under-triage 1.3%), a difference of 4.9% (95% CI, 1.5-8.2). CONCLUSIONS: The FDNY-START system may allow providers to prioritize casualties using an intermediate category (Orange) more properly aligned to meet patient needs, and as such, may reduce the rates of over-triage compared with START. The FDNY-START system decreases the variability in patient sorting while maintaining high field utility without needing computer assistance or extensive retraining. Comparison of triage algorithms at actual MCIs is needed; however, initial feedback is promising, suggesting that FDNY-START can improve triage with minimal additional training and cost.

Assessment of the safety and ease of use of the naloxone auto-injector for the reversal of opioid overdose.

Over the last decade, opioid-related deaths in the United States have increased at an alarming rate. The use of naloxone by laypersons is a newer concept and its utilization can benefit patients by rapid administration due to it being readily available immediately after an opioid overdose. The US Food and Drug Administration approved a naloxone auto-injector on April 3, 2014 for adults and pediatrics, designed for use by anyone including patients, family members, bystanders, and medical professionals. This device (EZVIO™) is the first device of its kind available on the market. The auto-injector is a battery-operated disposable 0.4 mg/0.4 mL prefilled device for use in the lateral thigh by patients, bystanders, or health care professionals. It utilizes auditory and visual commands for ease of administration and instructs patients to seek further medical care after injection. EVZIO costs about $600 for two auto-injectors and a trainer. Additionally, in August 2013, the Substance Abuse and Mental Health Services Administration introduced the Opioid Overdose Toolkit, a federal resource promoting safety and prevention information. This extensive document provides information for medical professionals, first responders, patients, caregivers, and overdose survivors. It outlines many strategies for dealing with this health care crisis. Most importantly, it highlights the importance of rapid recognition and treatment of opioid overdoses as well as routine conversations with patients assessing the need for naloxone prescriptions. The auto-injector is a safe, portable device with limited instruction needed and should routinely be made available to anyone who has contact with an opioid user.