“Simulation”, “deliberate practice”, “rehearsal” have been used to describe safe acquisition and practice of skills before patient contact. Simulation resources are being introduced as a General Medical Council mandate. Individual simulators have shown multi-level evidence but there is no guidance to form a simulation curriculum. We devised a pilot arthroscopy course based on a 4-stage model. Stage 1: session covering anatomy, equipment, and skills required; Stage 2: practice on low fidelity simulators (Arthroscopic Skills Acquisition Tools (ASATs), ArthroBox, Synthetic Knee); Stage 3: practice on high fidelity simulators (Cadaveric Knee, Virtual Reality); Stage 4: assessment on performance intra-operatively. This study sought feedback on Stages 1–3 with the aim that the feedback will help identify how trainees wish to use simulators. Five arthroscopic simulators were used in this one-day pilot course. Prior to commencing, participants were asked which simulator they felt would help them the most. Feedback on each stage, and individual simulator (Likert scale), and how trainees would like to be trained was prospectively collected. Seven orthopaedic juniors took part. All felt the high-fidelity simulators will be the most useful. All stages were ranked with equal importance, whilst cadaveric, plastic, VR, Arthrobox and lastly ASATs ranked in order of realism respectively. For cadaveric arthroscopy trainees wished the trainers to be there all the time (6/7), whilst for VR all trainees wanted their trainers part of the time. We have shown that junior trainees value a structured method of skills acquisition and have identified that high fidelity simulation requires trainers to be present to provide relevant feedback. Such feedback mechanisms need to be incorporated in any curriculum so that simulation tools are not seen as a standalone training method.
The aims of this study were to identify the early
in-hospital mortality rate after hip fracture, identify factors associated
with this mortality, and identify the cause of death in these patients.
A retrospective cohort study was performed on 4426 patients admitted
to our institution between the 1 January 2006 and 31 December 2013
with a hip fracture (1128 male (26%), mean age 82.0 years (60 to
105)). Admissions increased annually, but despite this 30-day mortality
decreased from 12.1% to 6.5%; 77% of these were in-hospital deaths.
Male gender (odds ratio (OR) 2.0, 95% confidence interval (CI) 1.3
to 3.0), increasing age (age ≥ 91; OR 4.1, 95% CI 1.4 to 12.2) and
comorbidity (American Society of Anesthesiologists grades 3 to 5;
OR 4.2, 95% CI 2.0 to 8.7) were independently and significantly
associated with increased odds of in-hospital mortality. From 220
post-mortem reports, the most common causes of death were respiratory
infections (35%), ischaemic heart disease (21%), and cardiac failure
(13%). A sub-group of hip fracture patients at highest risk of early
death can be identified with these risk factors, and the knowledge
of the causes of death can be used to inform service improvements
and the development of a more didactic care pathway, so that multidisciplinary
intervention can be focused for this sub-group in order to improve
their outcome. Cite this article:
Patient-reported outcome measures (PROMs) are increasingly being used to assess the quality of healthcare delivery in the United Kingdom. It is important when using PROMs to know the score of the background population against which any clinical intervention maybe benchmarked. The purpose of this study was to measure an elbow-specific PROM for the population of the South West Peninsula. We undertook a cross-sectional survey study of patients and healthcare professionals. Participants were asked to complete a simple demographic questionnaire and an Oxford Elbow Score for each elbow. Respondents with a history of elbow surgery, elbow injury, chronic elbow problems or an incomplete dataset were excluded from the study.Introduction
Methods
Periprosthetic Hip Fractures (PHFs) and Complex Revision Hip Arthroplasty(CRHA) consistently present challenging management decisions. Extramedullary devices alone or in combination with strut graft or long stem prosthesis revisions (cemented and uncemented) have all been described as treatment options. A long distal locked femoral stem provides an alternative allowing immediate stability for weight bearing without impaction bone grafting or external plate fixation and strut grafting. It has a lower risk of subsidence. 24 patients underwent a Cannulok Stem procedure from 2003–2008. Each was reviewed regularly following surgery with clinical examination and Hip scores (Oxford and SF12). The indications for device use, Vancouver classification if a periprostheic fracture, radiological evidence of union and complications were all recorded from medical and radiological records. The results were then compared to similar studies. The indications for Cannulok use were periprosthetic fracture (50%), infection with bone loss (12.5%), revision for aseptic loosening (33.3%) and subtrochanteric fracture post arthrodesis and metalwork removal (4.2%). A 75% union rate was seen in periprosthetic fractures. There were 2 deaths, 2 deep infections and 1 superficial infection. The 40 mm offset stems resulted in 6 (25%) dislocations compared to 0% dislocations with the 45 mm offset stem. In addition there was 1 femoral stem revision for subsidence (no distal locking screws used) and 1 acetabular revision. There was an average follow up of 20 months. This study suggests that the Cannulok Plus femoral reinforcement stem is a potential alternative treatment option in PHFs and CRHA with acceptable complication rates.
