Auditing the impact of implementing the Modern Matron role in an acute teaching trust.

AIM: This paper describes how an acute teaching trust established the role of Senior Nurses (Modern Matrons) and an audit that was undertaken 12 months after they were appointed to evaluate the role. BACKGROUND: The concept of the Modern Matron was introduced in 2000 and all trusts had to implement the role by April 2002. METHODS: The audit comprised: measurement of progress against agreed corporate objectives and questionnaires to all senior nurses and a range of trust staff staff. RESULTS: The following themes were identified: Senior Nurse post, patient care, infection control and leadership. Senior nurses were found to be satisfied with their role and the preparation for and understanding of their role seemed to be successful. There were many improvements such as a reduction in drug errors, complaints and MRSA bacteriaemias. CONCLUSIONS: Implementation of the Modern Matron role has been successful and made improvements in patient care.

Diagnostic values of tests for acromioclavicular joint pain.

BACKGROUND: This prospective study was performed to determine which clinical and imaging tests were most helpful for diagnosing acromioclavicular joint pain. METHODS: Of 1037 patients with shoulder pain, 113 who mapped pain within an area bounded by the midpart of the clavicle and the deltoid insertion were eligible for inclusion in the study. Forty-two subjects agreed to participate, and four of them were lost to follow-up. Twenty clinical tests, radiography, bone-scanning, magnetic resonance imaging, and an acromioclavicular joint injection test were performed on all patients. The patients were divided into two groups according to whether they had a > or =50% decrease in pain following the acromioclavicular joint injection. Statistical analysis, including multivariate regression analysis, was performed in order to evaluate the diagnostic effectiveness of the various tests. RESULTS: Acromioclavicular joint pain was confirmed in twenty-eight of the thirty-eight patients. The most sensitive tests were examination for acromioclavicular tenderness (96% sensitivity), the Paxinos test (79%), magnetic resonance imaging (85%), and bone-scanning (82%), but these studies had low specificity. In the stepwise regression model, with the response to the injection used as the dependent variable, bone-scanning and the Paxinos test were the only independent variables retained. Patients with a positive Paxinos test as well as a positive bone scan had high post-test odds (55:1) and a 99% post-test probability of having pain due to pathological changes in the acromioclavicular joint. The likelihood ratio for patients with one negative test and one positive test was indeterminate (0.4:1). Patients with both a negative Paxinos test and a negative bone scan had a likelihood ratio of 0.03:1 for having acromioclavicular joint pain, which basically rules out the disorder. CONCLUSIONS: The highly sensitive tests had low specificity, and the highly specific tests had low sensitivity. However, the combination of a positive Paxinos test and a positive bone scan predicted damage to the acromioclavicular joint as the cause of shoulder pain with a high degree of confidence.

Rotator cuff repair with bioabsorbable screws: An in vivo and ex vivo investigation.

PURPOSE: The purpose of this study was to evaluate in vivo the clinical outcomes of rotator cuff repairs with bioabsorbable screws compared with metal suture anchors, and to compare the ex vivo initial load to failure of rotator cuff repairs using 3 different bioabsorbable screws, suture anchors, and transosseous sutures. TYPE OF STUDY: In vivo clinical outcomes investigation, and ex vivo biomechanical study. METHODS: Three cohorts of patients with rotator cuff tears that measured less than 4 cm(2), were sequentially repaired with Mitek Rotator Cuff QuickAnchors (Mitek Surgical Products, Norwood, MA) (n = 9), Arthrex Headed Bio-Corkscrews (n = 9) (Arthrex, Naples, FL), and Mitek Rotator Cuff QuickAnchors (n = 9). Patients were systematically assessed with a specific shoulder questionnaire and 23 shoulder tests performed preoperatively and at 1 and 6 weeks, 3 and 6 months, and 1 year postoperatively. A correlative ex vivo biomechanical study was performed on 53 ovine shoulders to evaluate the initial failure load properties of bioabsorbable screws compared with fixation with suture anchors and transosseous sutures. RESULTS: In the in vivo portion of the study, the cohort treated with the Headed Bio-Corkscrew demonstrated no improvement on any measured parameter until 1-year after rotator cuff repair. In contrast, shoulders repaired with Mitek Rotator Cuff QuickAnchors demonstrated improved overall shoulder function as early as 6 weeks postoperatively (P =.002), had a better constant score at 1-year after repair (88 +/- 9 v 73 +/- 17; P =.016), and a lower rate of revision rotator cuff repair (P =.029). In the ex vivo portion of the study, the bioabsorbable headed screws, Headed Bio-Corkscrew (100 +/- 30 N) and BioTwist (76 +/- 35 N), had inferior initial failure load properties compared with suture anchors (140 +/- 36 N) and transosseous sutures (147 +/- 68 N). In contrast, the BioCuff (190 +/- 56 N), a bioabsorbable implant that used a screw and serrated washer design, had equivalent initial failure load properties as the suture repairs. CONCLUSIONS: This investigation had poorer early outcomes, a lower shoulder functional score 1-year after repair, and a higher rate of repeat surgery in patients who had their rotator cuff repaired with a bioabsorbable screw than in patients who had their shoulders repaired with a standard metal suture anchor. Furthermore, the biomechanical testing demonstrated a lower tensile load to failure in the tendons repaired with a simple screw design compared to suture anchors with a mattress stitch. Of note, the implant that used a screw and washer design demonstrated a greater ability to resist initial tensile load.