The COVID-19 pandemic presents an unprecedented burden on global healthcare systems, and existing infrastructures must adapt and evolve to meet the challenge. With health systems reliant on the health of their workforce, the importance of protection against disease transmission in healthcare workers (HCWs) is clear. This study collated responses from several countries, provided by clinicians familiar with practice in each location, to identify areas of best practice and policy so as to build consensus of those measures that might reduce the risk of transmission of COVID-19 to HCWs at work. A cross-sectional descriptive survey was designed with ten open and closed questions and sent to a representative sample. The sample was selected on a convenience basis of 27 senior surgeons, members of an international surgical society, who were all frontline workers in the COVID-19 pandemic. This study was reported according to the Standards for Reporting Qualitative Research (SRQR) checklist.Aims
Methods
Greater length of stay (LOS) after elective surgery results in increased use of health care resources and higher costs. Within the realm of foot and ankle surgery, improved perioperative care has enabled a vast majority of procedures to be performed as a day surgery. The objective of this study was to determine the perioperative factors that predict a prolonged LOS after elective ankle replacement or fusion. Data was prospectively collected on patients undergoing either an ankle fusion or ankle replacement for end-stage ankle arthritis at our institution (2003–2010). In the analysis, LOS was the outcome and age, sex, physical and mental functional scores, comorbid factors, ASA grades, type and length of operation and body mass index (BMI) were potential perioperative risk factors. Univariate and multivariate generalized linear regression models with gamma distribution and log link function were conducted.Introduction
Methods
Conventional instrumentation, 3D plan based on a CT scan of the particular bone, helped by a conventional jig Navigation system. This achieved angle was then compared with the angle originally planned for each bone in all three groups using digitizing arm.
Complications following hip resurfacing occur primarily because of the surgeon’s inability to achieve optimal implant positioning, and the significant learning curve associated with it. Our study sought to look at the impact of navigation technologies on this learning curve. Twenty medical students doing their BSc project took part in the study. Four types of synthetic femurs were used for the study viz., Normal anatomy (11students), Osteoarthritis (5), Coxa Vara(2) and Coxa Valga(2). Each student was allowed to insert the guide wire according to their judgement in the femoral head using 3 systems: Conventional instrumentation, 3D plan based on a CT scan of the particular bone, helped by a conventional jig and Navigation system. This achieved angle was then compared with the angle originally planned for each bone in all three groups using digitizing arm. The range of error using the conventional method to insert a guide wire was 23deg (range −9 to 14, SD= 6.3), using the CT plan method, it was 22 deg (range −9 to 13, SD=6.6). Using the Navigation method it was 7 deg (range −5 to 2, SD=2.). Students who progressed from conventional through planning to navigation (group 1) were no more accurate than students who went straight to navigation without ever having used conventional instrumentation (group 3). Students produced similar accuracy even in their maiden attempt, on difficult anatomy when provided with navigation technology. This study has shown that motivated and enthusiastic students can achieve an expert level of accuracy very rapidly when provided with the appropriate level of technology. he development of surgeons who are able to deliver excellent outcomes depends more on technology than training.
Functional evaluations using the Harris hip scoring system and the delayed Trendelenberg test were performed on fifty randomly selected patients who had undergone cemented primary CPT total hip replacements (Zimmer UK) at least 12 months previously using Hardinge approach. The prosthesis used increases offset with femoral stem diameter but did not allow separate correction of neck offset. Patients were grouped according to whether hip offset had been accurately reconstructed, increased or decreased. Their functional outcomes were compared. There was no significant difference (p value 0.57) in the final functional outcome between the three groups. Reconstruction of the hip using a standard cemented CPT prosthesis produced considerable variation in the reconstructed hip arthroplasty offset. This resulted in no functionally significant effect. Accurate reconstruction of the hip joint offset in total hip arthroplasty may therefore not be as important in the early functional outcome as recently advocated.
