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Orthopaedic Proceedings
Vol. 105-B, Issue SUPP_17 | Pages 49 - 49
24 Nov 2023
Azamgarhi T Perez-Sanchez C Warren S Scobie A Karunaharan N Houghton R Hassan S Kershaw H Sendi P Saeed K
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Aim

Dalbavancin is a lipoglycopeptide with a half-life of 14 days (range 6.1 to 18.4), significantly longer than other antimicrobials, which avoids the need for daily antibiotic dosing. This multi-centre observational study aims to describe the use of dalbavancin to facilitate discharge in treating bone and joint infections.

Method

All adult patients treated with dalbavancin from January 2017 to September 2022 in four UK bone infection units were included.

Data collected through a standardised data collection form included:

Clinical and microbiological characteristics.

Hospital length of stay.

Complications.

Patient suitability for hypothetical treatment options, such as Outpatient Parenteral

Antibiotic Team (OPAT)

Clinical outcome.

Treatment-related costs were calculated for dalbavancin and the preferred hypothetical treatment option that would have been administered for the same duration. The costs were subtracted to calculate the cost difference.

Clinical success was defined as the absence of definite failure in accordance with the OVIVA Trial protocol.


Orthopaedic Proceedings
Vol. 105-B, Issue SUPP_8 | Pages 128 - 128
11 Apr 2023
Elbahi A Onazi O Ramadan M Hanif Y Eastley N Houghton-Clemmey R
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It is known that Osteoporosis is the pathology of bone mass and tissue loss resulting in an increase of fragility, risk of fracture occurrence, and risk of fracture recurrence. We noted there was no definitive pathway in our last audit, therefore recommended: availability of the Osteoporosis clinic referral form in an accessible place, the form be filled by the doctor reviewing the patient in the first fracture clinic, and a liaison nurse to ensure these forms were filled and sent to the Osteoporosis clinic. This second audit analyses our Trust's response to these recommendations and effect achieved in Osteoporosis care.

We reviewed our local data base from the 7/27/2020 – 10/2/2021 retrospectively for distal radius fractures who were seen in fracture clinic. We analysed a sample size of 59 patients, excluding patients who had already commenced bone protection medications.

67.7% of our patients had neither been on bone protection medications nor recorded referrals and 13.5% were already on bone protection medications when they sustained the fragility fracture. Ten out of the 51 patients were offered referral to the osteoporosis clinic, and one refused. This makes 20% (10 out of 50) of the patients had completed referrals. In comparison, in our first audit, 11% had already been on bone protection medications and 18% had completed referrals. The second cycle showed a slight increase in compliance. Majority of the referrals were completed by Orthopaedic Consultants in both audits and ana awareness increase noted among non-consultants in starting the referral process.

Based on our analysis, our Trust has a slight improvement in commencing bone protection medications, associated with slight improvement in completing referrals to the Osteoporosis clinic. Despite our recommendations in the first audit, there is still no easily accessible definitive pathway to ensure our Trust's patients have timely access to bone protection and continued care at the Osteoporosis clinic. We recommend streamlining our recommendations to have a more effective approach in ensuring our Trust meets national guidelines. We will implement a Yes or No question assessment for patients visiting clinic in our electronic database which should assist in referral completions.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_III | Pages 416 - 417
1 Jul 2010
Carrothers AD Jones BS Devaney A Houghton R Jones RS
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Introduction: As knee arthroplasty is becoming more commonplace in the working population its outcome and probability of return to work is of interest. Despite a wealth of anecdotal evidence about patient return to work post knee arthroplasty there is nothing published in the recent literature. The NHS Direct patient information website quotes patients return to work about 6 to 8 weeks post knee arthroplasty. In order to address this lack of informed information we conducted a retrospective survey.

Methods: 148 consecutive patients of working age, who underwent knee arthroplasty in 2007 were identified by our Electronic Patients Record. (52 male, 96 female, average age 58 years (range 37–65 years)) They were asked to complete a simple questionnaire relating to their occupational history, arthroplasty satisfaction and their current working capacity.

Results: Our survey had a response rate of 67% (99/148 responders, 64 female and 35 male), with a range of follow up from 7 to 19 months. 39% of patients were in employment at the time of their arthroplasty, with 46 % (46/99) returning to some working capacity post surgery. 32% (32/99) patients were able to return to their exact same employment. 88% (28/32) of these patients had worked up to the date of their arthroplasty. There was no correlation between operative indication or type of prosthesis implanted and patients who returned to employment and those who did not.

Conclusion: Despite high expectation in lay literature of ability to work post knee arthroplasty, only 46% of our patients returned to any form of employment. For patients who returned to work, the duration of sick leave prior to their surgery was a strong predictor of whether they returned to any form of employment. Caution must be exercised when informing patients of likelihood of return to work post knee arthroplasty.